MEDICARE: COASTAL HOME HEALTH CARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1174861512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL HOME HEALTH CARE, INC

Provider Business Mailing Address
First Line	:	1220 BLALOCK RD
Second Line	:	140
City	:	HOUSTON
State	:	TX
Zip	:	77055-6472
Country	:	US
Telephone Number	:	214-290-4624
Fax Number	:

Provider Business Practice Location Address
First Line	:	4359 RITTIMAN RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-4362
Country	:	US
Telephone Number	:	713-623-1391
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SEOUNG JU RYOU
Credential	:	RN
Telephone Number	:	214-670-2337

Provider Enumeration Date	:	01/18/2013
Last Update Date	:	07/15/2014

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