Healthcare Provider Details

I. General information

NPI: 1699603969
Provider Name (Legal Business Name): COASTAL COMFORT HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5285 MAIN ST STE 19D
SHALLOTTE NC
28470-3458
US

IV. Provider business mailing address

5285 MAIN ST STE 19D
SHALLOTTE NC
28470-3458
US

V. Phone/Fax

Practice location:
  • Phone: 910-729-6633
  • Fax: 910-720-0027
Mailing address:
  • Phone: 910-729-6633
  • Fax: 910-720-0027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MISTY RIGGAN
Title or Position: AGENCY DIRECTOR/OWNER
Credential:
Phone: 910-729-6633