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General NPI Number Information
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NPI Number | 1336124270
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Entity Type | Organization
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Legal Business Name | COASTAL PLAINS HOME HEALTH AGENCY 9A
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1102 45TH AVE
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City | GULFPORT
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State | MS
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Zip | 39501-2504
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Country | US
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Telephone | 228-867-6115
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Fax | 228-867-6185
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Provider Business Mailing Address
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Address Line | 1102 45TH AVE
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City | GULFPORT
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State | MS
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Zip | 39501-2504
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Country | US
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Telephone | 228-867-6115
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Fax | 228-867-6185
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Authorized Official
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Title or Position | DIRECTOR OF FINANCE ADMINISTRATION
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Name | MR. MITCHELL ADCOCK
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Credential | CPA CIA CFE
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Telephone | 601-576-7853
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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 | 3481
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License Number State | MS
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