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General NPI Number Information
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NPI Number | 1336772292
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Entity Type | Organization
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Legal Business Name | COASTAL COMMUNITY CARE LLC
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Dates
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Enumeration Date | 02/19/2020
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 731 AIRPORT RD STE G
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City | PANAMA CITY
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State | FL
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Zip | 32405-4031
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Country | US
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Telephone | 850-852-1058
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Fax | 850-852-1059
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Provider Business Mailing Address
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Address Line | 731 AIRPORT RD STE G
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City | PANAMA CITY
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State | FL
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Zip | 32405-4031
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Country | US
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Telephone | 850-852-1058
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Fax | 850-852-1059
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Authorized Official
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Title or Position | OWNER
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Name | CASSAUNDRA NANCE
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Credential |
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Telephone | 850-319-5693
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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 |
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License Number State |
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