Provider Demographics
NPI:1083709984
Name:COASTAL HOSPICE INC
Entity Type:Organization
Organization Name:COASTAL HOSPICE INC
Other - Org Name:COASTAL HOSPICE AND PALLIATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALANE
Authorized Official - Middle Name:K
Authorized Official - Last Name:CAPEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BS, CHPN
Authorized Official - Phone:410-742-8732
Mailing Address - Street 1:PO BOX 1733
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-1733
Mailing Address - Country:US
Mailing Address - Phone:410-742-8732
Mailing Address - Fax:410-543-8213
Practice Address - Street 1:2604 OLD OCEAN CITY RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-4629
Practice Address - Country:US
Practice Address - Phone:410-742-8732
Practice Address - Fax:410-543-8213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH1505251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD536295403Medicaid
MDMH4OtherHOSPICE
MDMH8OtherHOSPICE
MD02SGOtherHOSPICE
MD139353700Medicaid
MDMH4OtherHOSPICE
MD139353700Medicaid