Healthcare Provider Details

I. General information

NPI: 1780276659
Provider Name (Legal Business Name): COASTLINE SENIOR CARE SOLUTIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 W 260TH ST STE 4
HARBOR CITY CA
90710
US

IV. Provider business mailing address

1622 W 260TH ST STE 4
HARBOR CITY CA
90710
US

V. Phone/Fax

Practice location:
  • Phone: 310-422-1477
  • Fax: 310-734-1631
Mailing address:
  • Phone: 310-422-1477
  • Fax: 310-734-1631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MRS. PENELOPY JORDAN
Title or Position: EXECUTIVE DIRECTOR
Credential: E.A.
Phone: 213-205-7007