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General NPI Number Information
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NPI Number | 1144305004
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Entity Type | Organization
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Legal Business Name | COASTAL MEDICAL SERVICES, INC.
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 02/02/2012
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Provider Practice Location Address
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Address Line | 8303 SOUTHWEST FWY STE 820
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City | HOUSTON
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State | TX
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Zip | 77074-1638
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Country | US
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Telephone | 713-771-8470
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Fax | 713-771-8474
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Provider Business Mailing Address
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Address Line | 8303 SOUTHWEST FWY STE 820
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City | HOUSTON
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State | TX
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Zip | 77074-1638
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Country | US
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Telephone | 713-771-8470
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Fax | 713-771-8474
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Authorized Official
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Title or Position | DON/ALTERNATE ADMINISTRATOR
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Name | MRS. IMEH OKPON JACK
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Credential | RN
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Telephone | 713-771-8470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 005445
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License Number State | TX
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