Healthcare Provider Details

I. General information

NPI: 1912990235
Provider Name (Legal Business Name): COASTAL NURSECARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3216 SHRINE RD
BRUNSWICK GA
31520-4325
US

IV. Provider business mailing address

3216 SHRINE RD
BRUNSWICK GA
31520-4325
US

V. Phone/Fax

Practice location:
  • Phone: 912-264-0040
  • Fax: 912-261-1292
Mailing address:
  • Phone: 912-264-0040
  • Fax: 912-261-1292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number063-R-0004
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number063-R-0004
License Number StateGA

VIII. Authorized Official

Name: MRS. EMILY C. DAVENPORT
Title or Position: PRESIDENT
Credential:
Phone: 912-264-0040