Provider Demographics
NPI:1871925495
Name:EAST COAST HABILITATION OPTIONS
Entity type:Organization
Organization Name:EAST COAST HABILITATION OPTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:REITER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-983-2348
Mailing Address - Street 1:17 BUFFALO PLAINS LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-9458
Mailing Address - Country:US
Mailing Address - Phone:386-264-6953
Mailing Address - Fax:386-264-6136
Practice Address - Street 1:17 BUFFALO PLAINS LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-9458
Practice Address - Country:US
Practice Address - Phone:386-264-6953
Practice Address - Fax:386-264-6136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008197400Medicaid