MEDICARE: COACHMAN, 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	310400000X	Assisted Living Facility	AL7589	FL

General Provider Information

NPI Number	:	1851633929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COACHMAN, INC.

Provider Business Mailing Address
First Line	:	PO BOX 8071
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33758-8071
Country	:	US
Telephone Number	:	727-442-2971
Fax Number	:

Provider Business Practice Location Address
First Line	:	2143 NE COACHMAN RD
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33765-2633
Country	:	US
Telephone Number	:	727-442-2971
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ANGEL L. MALAPIRA
Credential	:	RETIRED MILITARY
Telephone Number	:	727-442-2971

Provider Enumeration Date	:	03/26/2013
Last Update Date	:	03/26/2013

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Directions to “COACHMAN, INC. ” Practice Location

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