Provider Demographics
NPI:1306862198
Name:INTERCOASTAL HEALTH CARE, INC.
Entity Type:Organization
Organization Name:INTERCOASTAL HEALTH CARE, INC.
Other - Org Name:SEA CREST HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:JULIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-556-8296
Mailing Address - Street 1:414 S LIVE OAK ST
Mailing Address - Street 2:
Mailing Address - City:LAMPASAS
Mailing Address - State:TX
Mailing Address - Zip Code:76550-2940
Mailing Address - Country:US
Mailing Address - Phone:512-556-8296
Mailing Address - Fax:512-564-1100
Practice Address - Street 1:801 E MARKET ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-2533
Practice Address - Country:US
Practice Address - Phone:361-729-0340
Practice Address - Fax:361-814-5305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX014456251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4633505-01Medicaid
TX4633505-01Medicaid