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General NPI Number Information
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NPI Number | 1720439904
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Entity Type | Organization
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Legal Business Name | COASTAL LIVING HOME HEALTH LLC
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Dates
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Enumeration Date | 06/28/2016
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Last Update Date | 06/28/2016
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Provider Practice Location Address
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Address Line | 200 S 13TH ST SUITE 211 & 212
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City | GROVER BEACH
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State | CA
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Zip | 93433-3302
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Country | US
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Telephone | 805-335-8441
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Fax | 805-980-5705
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Provider Business Mailing Address
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Address Line | 200 S 13TH ST SUITE 211 & 212
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City | GROVER BEACH
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State | CA
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Zip | 93433-3302
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Country | US
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Telephone | 805-335-8441
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Fax | 805-980-5705
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JASON PAUL BLISS
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Credential |
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Telephone | 805-335-8441
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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 |
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License Number State |
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