Provider Demographics
NPI:1083495949
Name:COASTLINE CARE SERVICES, LLC
Entity Type:Organization
Organization Name:COASTLINE CARE SERVICES, LLC
Other - Org Name:GRISWOLD HOME CARE FOR GREATER NEWPORT BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-996-8848
Mailing Address - Street 1:2152 DUPONT DR STE 275
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1354
Mailing Address - Country:US
Mailing Address - Phone:949-996-8848
Mailing Address - Fax:949-996-8848
Practice Address - Street 1:2152 DUPONT DR STE 275
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1354
Practice Address - Country:US
Practice Address - Phone:949-996-8848
Practice Address - Fax:949-996-8848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-06
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care