Provider Demographics
NPI:1356651673
Name:COASTAL CARE MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:COASTAL CARE MEDICAL SUPPLY, INC.
Other - Org Name:HME PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FEDELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-265-4310
Mailing Address - Street 1:1800 W WOOLBRIGHT RD
Mailing Address - Street 2:200
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-6398
Mailing Address - Country:US
Mailing Address - Phone:561-819-0460
Mailing Address - Fax:561-207-7781
Practice Address - Street 1:755 NW 17TH AVE
Practice Address - Street 2:105
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-2522
Practice Address - Country:US
Practice Address - Phone:561-265-4310
Practice Address - Fax:561-214-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1887332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1887OtherAHCA