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General NPI Number Information
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NPI Number | 1104151000
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Entity Type | Organization
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Legal Business Name | COASTAL OAKS HOMECARE INC
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Dates
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Enumeration Date | 10/09/2009
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Last Update Date | 10/09/2009
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Provider Practice Location Address
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Address Line | 3869 S NOVA RD UNIT 2
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City | PORT ORANGE
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State | FL
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Zip | 32127-4246
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Country | US
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Telephone | 386-322-9375
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Fax | 386-761-7804
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Provider Business Mailing Address
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Address Line | 3869 S NOVA RD UNIT 2
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City | PORT ORANGE
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State | FL
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Zip | 32127-4246
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Country | US
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Telephone | 386-322-9375
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Fax | 386-761-7804
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. SANDRA E YATES
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Credential |
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Telephone | 386-322-9375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 30211232
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License Number State | FL
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