Provider Demographics
NPI:1184215741
Name:COASTAL HOMECARE
Entity Type:Organization
Organization Name:COASTAL HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SASHA
Authorized Official - Middle Name:YEVETT
Authorized Official - Last Name:PERTUIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-606-6228
Mailing Address - Street 1:406 GEORGETOWN DR
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065
Mailing Address - Country:US
Mailing Address - Phone:504-738-4406
Mailing Address - Fax:
Practice Address - Street 1:406 GEORGETOWN DR
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065
Practice Address - Country:US
Practice Address - Phone:504-738-4406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care