MEDICARE: COASTAL HEALTHCARE SOLUTIONS

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	:	1649518994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL HEALTHCARE SOLUTIONS

Provider Business Mailing Address
First Line	:	2505 METROCENTRE BLVD
Second Line	:	SUITE 203
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3114
Country	:	US
Telephone Number	:	561-689-2774
Fax Number	:	561-491-0400

Provider Business Practice Location Address
First Line	:	2505 METROCENTRE BLVD
Second Line	:	SUITE 203
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3114
Country	:	US
Telephone Number	:	561-689-2774
Fax Number	:	561-491-0400

Authorized Official
Title or Position	:	DIVISIONAL PRESIDENT
Name	:	MR. MARC DOMB
Credential	:
Telephone Number	:	561-689-2774

Provider Enumeration Date	:	01/22/2013
Last Update Date	:	01/22/2013

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