Healthcare Provider Details

I. General information

NPI: 1700361821
Provider Name (Legal Business Name): COASTAL NURSING ASSISTANT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6842 RICHARD LN
EIGHT MILE AL
36613-9650
US

IV. Provider business mailing address

6842 RICHARD LN
EIGHT MILE AL
36613-9650
US

V. Phone/Fax

Practice location:
  • Phone: 251-643-4181
  • Fax:
Mailing address:
  • Phone: 251-643-4181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: VCITORIA HOWARD
Title or Position: OWNER
Credential:
Phone: 251-643-4181