1558392209 NPI number — COASTAL HOME CARE SERVICES, INC.

Table of content: (NPI 1558392209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558392209 NPI number — COASTAL HOME CARE SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COASTAL HOME CARE SERVICES, INC.
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:
CHOICE HOME HEALTH 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:
1558392209
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3340 TULLY RD
Provider Second Line Business Mailing Address:
SUITE C-8A
Provider Business Mailing Address City Name:
MODESTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95350-0838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-524-8700
Provider Business Mailing Address Fax Number:
209-524-8701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 GARDEN CT
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
MONTEREY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93940-5367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-645-1400
Provider Business Practice Location Address Fax Number:
831-657-1996
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
O'SULLIVAN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
VINCENT
Authorized Official Title or Position:
SECRETARY/TREASURER
Authorized Official Telephone Number:
209-524-8700

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 0700000367 , 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)

  • Identifier: HHA574061G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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