Provider Demographics
NPI:1093835423
Name:COASTAL HOME CARE
Entity Type:Organization
Organization Name:COASTAL HOME CARE
Other - Org Name:AMERICAN HOMEPATIENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-221-8149
Mailing Address - Street 1:PO BOX 532549
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-2549
Mailing Address - Country:US
Mailing Address - Phone:843-821-8525
Mailing Address - Fax:843-821-0982
Practice Address - Street 1:9657 OCEAN HIGHWAY
Practice Address - Street 2:BUILDING B, SUITE 3
Practice Address - City:PAWLEY'S ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585
Practice Address - Country:US
Practice Address - Phone:843-235-3910
Practice Address - Fax:843-235-3965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
0652920003Medicare NSC