Healthcare Provider Details

I. General information

NPI: 1093835423
Provider Name (Legal Business Name): COASTAL HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9657 OCEAN HIGHWAY BUILDING B, SUITE 3
PAWLEY'S ISLAND SC
29585
US

IV. Provider business mailing address

PO BOX 532549
ATLANTA GA
30353-2549
US

V. Phone/Fax

Practice location:
  • Phone: 843-235-3910
  • Fax: 843-235-3965
Mailing address:
  • Phone: 843-821-8525
  • Fax: 843-821-0982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANK POWERS
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 615-221-8149