1043763071 NPI number — COASTAL COMMUNITY SENIOR CARE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043763071 NPI number — COASTAL COMMUNITY SENIOR CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COASTAL COMMUNITY SENIOR CARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HOME INSTEAD SENIOR CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043763071
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5500 E ATHERTON ST
Provider Second Line Business Mailing Address:
SUITE 216
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90815-4016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-596-4884
Provider Business Mailing Address Fax Number:
562-596-7334

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5500 E ATHERTON ST
Provider Second Line Business Practice Location Address:
SUITE 216
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90815-4016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-596-4884
Provider Business Practice Location Address Fax Number:
562-596-7334
Provider Enumeration Date:
07/26/2016

Additional Information

Authorized Official

Authorized Official Last Name:
PIERCE
Authorized Official First Name:
DON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
562-696-4884

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  194700062 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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