Healthcare Provider Details

I. General information

NPI: 1629998836
Provider Name (Legal Business Name): COASTAL HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 W GRANADA BLVD STE 6A
ORMOND BEACH FL
32174-8105
US

IV. Provider business mailing address

1275 W GRANADA BLVD STE 6A 1275 W GRANADA BLVD STE 6A
ORMOND BEACH FL
32174-8105
US

V. Phone/Fax

Practice location:
  • Phone: 386-281-7372
  • Fax: 888-261-3967
Mailing address:
  • Phone: 386-281-7372
  • Fax: 386-281-7372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRENDA KABBES
Title or Position: MANAGING MANAGER
Credential: KABBES
Phone: 386-281-7372