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
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1346959996
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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3920 ARKWRIGHT RD STE 185
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31210-1731
Country	:	US
Telephone Number	:	478-750-0886
Fax Number	:

Authorized Official
Title or Position	:	CHIEF LEGAL OFFICER
Name	:	JOSEPH BONACCORSI
Credential	:
Telephone Number	:	312-762-9999

Provider Enumeration Date	:	11/22/2022
Last Update Date	:	04/29/2025

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