Healthcare Provider Details

I. General information

NPI: 1285777490
Provider Name (Legal Business Name): COASTAL HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1149 CORNELL AVE STE A
SAVANNAH GA
31406-2700
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 912-354-3680
  • Fax:
Mailing address:
  • Phone: 312-762-9999
  • Fax: 912-355-8738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number025R0271
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number016R0270
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number063R0272
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

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