Provider Demographics
NPI:1528674074
Name:COASTAL HEALTH INSTITUTE, LLC
Entity type:Organization
Organization Name:COASTAL HEALTH INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-537-2254
Mailing Address - Street 1:11555 CENTRAL PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-2693
Mailing Address - Country:US
Mailing Address - Phone:904-537-2254
Mailing Address - Fax:
Practice Address - Street 1:11555 CENTRAL PKWY STE 201
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-2693
Practice Address - Country:US
Practice Address - Phone:904-537-2254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty