Provider Demographics
NPI:1144305723
Name:COASTAL HORIZONS CENTER, INC.
Entity type:Organization
Organization Name:COASTAL HORIZONS CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTTMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-343-0145
Mailing Address - Street 1:523 MILL CREEK CT
Mailing Address - Street 2:APT. C
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-8529
Mailing Address - Country:US
Mailing Address - Phone:910-524-0365
Mailing Address - Fax:910-341-5779
Practice Address - Street 1:615 SHIPYARD BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-6431
Practice Address - Country:US
Practice Address - Phone:910-343-0145
Practice Address - Fax:910-341-5779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC190232261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6004050Medicaid
NC2809959Medicare ID - Type Unspecified