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General NPI Number Information
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NPI Number | 1417393232
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Entity Type | Organization
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Legal Business Name | COA HOME CARE, LLC
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Dates
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Enumeration Date | 05/20/2013
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Last Update Date | 10/02/2020
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Provider Practice Location Address
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Address Line | 420 FENTRESS BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-1208
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Country | US
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Telephone | 386-253-4700
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Fax | 386-253-6300
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Provider Business Mailing Address
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Address Line | 420 FENTRESS BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-1208
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Country | US
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Telephone | 386-283-4700
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Fax | 386-253-6300
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MS. TERRI D. KAROL
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Credential |
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Telephone | 386-253-4700
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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 | 299994192
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License Number State | FL
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