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NPI Code Detail

MEDICARE: COASTAL HOME CARE, LLC

MEDICARE: COASTAL HOME CARE, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251E00000XHome Health Agency016-R-0270GA
2253Z00000XIn Home Supportive Care Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265873368
Entity Type Code : Organization
Provider Name (Legal Business Name) : COASTAL HOME CARE, LLC
Provider Business Mailing Address
First Line : 33 S STATE ST FL 5
Second Line :
City : CHICAGO
State : IL
Zip : 60603-2804
Country : US
Telephone Number : 312-762-9999
Fax Number :
Provider Business Practice Location Address
First Line : 3633 WHEELER RD STE 330
Second Line :
City : AUGUSTA
State : GA
Zip : 30909-6552
Country : US
Telephone Number : 706-955-8783
Fax Number :
Authorized Official
Title or Position : CHIEF LEGAL OFFICER
Name : JOSEPH BONACCORSI
Credential :
Telephone Number : 312-762-9999
Provider Enumeration Date : 07/17/2013
Last Update Date : 04/29/2025

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