MEDICARE: COASTAL HEALTH SERVICES, 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		FL

General Provider Information

NPI Number	:	1538264882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	6320 SAINT AUGUSTINE RD
Second Line	:	SUITE 4
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2800
Country	:	US
Telephone Number	:	904-419-4994
Fax Number	:	904-419-4990

Provider Business Practice Location Address
First Line	:	6320 SAINT AUGUSTINE RD
Second Line	:	SUITE 4
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2800
Country	:	US
Telephone Number	:	904-419-4994
Fax Number	:	904-419-4990

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. PETER J HEBERT
Credential	:
Telephone Number	:	904-419-4994

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	08/22/2020

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Directions to “COASTAL HEALTH SERVICES, INC. ” Practice Location

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