Provider Demographics
NPI:1235279027
Name:COASTAL HUMAN RESOURCES LLC
Entity Type:Organization
Organization Name:COASTAL HUMAN RESOURCES LLC
Other - Org Name:COMFORT KEEPERS #265
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:OGBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-249-9200
Mailing Address - Street 1:3009 CHURCH ST STE B
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5983
Mailing Address - Country:US
Mailing Address - Phone:843-249-9200
Mailing Address - Fax:843-249-3931
Practice Address - Street 1:3009 CHURCH ST STE B
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5983
Practice Address - Country:US
Practice Address - Phone:843-249-9200
Practice Address - Fax:843-249-3931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC 3913253Z00000X
SC253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care