Healthcare Provider Details

I. General information

NPI: 1457353765
Provider Name (Legal Business Name): COASTAL HOSPICE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 MCKEOUGH AVE
SARALAND AL
36571-3227
US

IV. Provider business mailing address

90 MCKEOUGH AVE
SARALAND AL
36571-3227
US

V. Phone/Fax

Practice location:
  • Phone: 251-675-0012
  • Fax: 251-675-3303
Mailing address:
  • Phone: 251-675-0012
  • Fax: 251-675-3303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number11164
License Number StateAL

VIII. Authorized Official

Name: MR. WILLIAM MONTE ELLIOTT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 251-675-0012