Healthcare Provider Details

I. General information

NPI: 1801237243
Provider Name (Legal Business Name): COASTAL HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 GLOUCESTER ST STE 300
BRUNSWICK GA
31520-7068
US

IV. Provider business mailing address

33 S STATE ST FL 5
CHICAGO IL
60603-2804
US

V. Phone/Fax

Practice location:
  • Phone: 912-264-5363
  • Fax:
Mailing address:
  • Phone: 312-762-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number063-R-0272
License Number StateGA

VIII. Authorized Official

Name: JOSEPH BONACCORSI
Title or Position: CHIEF LEGAL OFFICER
Credential:
Phone: 312-762-9999