Provider Demographics
NPI:1043763071
Name:COASTAL COMMUNITY SENIOR CARE, LLC
Entity Type:Organization
Organization Name:COASTAL COMMUNITY SENIOR CARE, LLC
Other - Org Name:HOME INSTEAD SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:562-696-4884
Mailing Address - Street 1:5500 E ATHERTON ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-4016
Mailing Address - Country:US
Mailing Address - Phone:562-596-4884
Mailing Address - Fax:562-596-7334
Practice Address - Street 1:5500 E ATHERTON ST
Practice Address - Street 2:SUITE 216
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-4016
Practice Address - Country:US
Practice Address - Phone:562-596-4884
Practice Address - Fax:562-596-7334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA194700062253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care