| Organization Name: | COASTAL HAVEN HOME |
| NPI Number: | 1164647277 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WANDA DENISE WILSON (ADMINISTRATOR) |
| Mailing Address: | 399 Doe Run Dr. Supply |
| State: | NC US |
| Postal Code: | 284626349 |
| Phone Number: | 9108469196 |
| Fax Number: | |
| NPI Enumeration Date: | 04/16/2007 |
| NPI Last Update Date: | 06/27/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320800000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |