Provider Demographics
NPI:1376978783
Name:ISLAND COAST HOME HEALTH LLC
Entity Type:Organization
Organization Name:ISLAND COAST HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, COS-C
Authorized Official - Phone:239-634-4194
Mailing Address - Street 1:4456 TAMIAMI TRL
Mailing Address - Street 2:A-10 #3
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33980-2101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4456 TAMIAMI TRL
Practice Address - Street 2:A-10 #3
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33980-2101
Practice Address - Country:US
Practice Address - Phone:941-766-7201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health