Provider Demographics
NPI:1144523671
Name:COASTAL BEND WELLNESS FOUNDATION INC
Entity type:Organization
Organization Name:COASTAL BEND WELLNESS FOUNDATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:JERON
Authorized Official - Last Name:HOELSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-814-2001
Mailing Address - Street 1:5633 S STAPLES ST STE 700
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4679
Mailing Address - Country:US
Mailing Address - Phone:361-814-2001
Mailing Address - Fax:361-883-1998
Practice Address - Street 1:2882 HOLLY RD.
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415
Practice Address - Country:US
Practice Address - Phone:361-814-2001
Practice Address - Fax:361-883-1998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX291803903Medicaid