MEDICARE: COASTAL HOME CARE, LLC

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	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency	085-R-1045	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	PHCP010607	OTHER	GA	PERMIT

General Provider Information

NPI Number	:	1255772695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL HOME CARE, LLC

Provider Business Mailing Address
First Line	:	33 S STATE ST FL 5
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60603-2804
Country	:	US
Telephone Number	:	312-762-9999
Fax Number	:

Provider Business Practice Location Address
First Line	:	2970 CLAIRMONT RD NE STE 305
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30329-1638
Country	:	US
Telephone Number	:	770-376-3133
Fax Number	:

Authorized Official
Title or Position	:	CHIEF LEGAL OFFICER
Name	:	JOSEPH BONACCORSI
Credential	:
Telephone Number	:	312-762-9999

Provider Enumeration Date	:	07/15/2013
Last Update Date	:	05/08/2025

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Directions to “COASTAL HOME CARE, LLC ” Practice Location

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