Provider Demographics
NPI:1376925867
Name:COAST TO COAST HEALTHCARE SOLUTIONS, INC
Entity Type:Organization
Organization Name:COAST TO COAST HEALTHCARE SOLUTIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-999-9295
Mailing Address - Street 1:4700 N STATE ROAD 7
Mailing Address - Street 2:SUITE A-101
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5800
Mailing Address - Country:US
Mailing Address - Phone:954-667-1125
Mailing Address - Fax:954-667-1130
Practice Address - Street 1:4700 N STATE ROAD 7 STE A-101
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5800
Practice Address - Country:US
Practice Address - Phone:954-667-1125
Practice Address - Fax:954-667-1130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-22
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211118251E00000X
251J00000X, 253Z00000X, 3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL687228004OtherMEDICAID WAIVER
FL687228006Medicaid