Provider Demographics
NPI:1043459464
Name:INTER-COASTAL HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:INTER-COASTAL HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:CID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-353-1474
Mailing Address - Street 1:1388 NW 2ND AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-1631
Mailing Address - Country:US
Mailing Address - Phone:561-353-1474
Mailing Address - Fax:561-347-8481
Practice Address - Street 1:1388 NW 2ND AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1631
Practice Address - Country:US
Practice Address - Phone:561-353-1474
Practice Address - Fax:561-347-8481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA29991618251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health