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General NPI Number Information
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NPI Number | 1740221043
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Entity Type | Organization
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Legal Business Name | COASTAL HOME HEALTH INC
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 3515 FANNIN ST SUITE 101
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City | BEAUMONT
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State | TX
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Zip | 77701-3815
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Country | US
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Telephone | 409-835-1518
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Fax | 409-835-1164
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Provider Business Mailing Address
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Address Line | 3515 FANNIN ST SUITE 107
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City | BEAUMONT
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State | TX
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Zip | 77701-3815
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Country | US
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Telephone | 409-835-1518
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Fax | 409-835-1164
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Authorized Official
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Title or Position | CEO
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Name | MR. PENNY ARMENDA GARNER
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Credential | RN
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Telephone | 409-835-1518
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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 | 007283
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License Number State | TX
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