Provider Demographics
NPI:1407398571
Name:COASTAL HOME HEALTH LLC DBA IN HOME PERSONAL SERVICES
Entity Type:Organization
Organization Name:COASTAL HOME HEALTH LLC DBA IN HOME PERSONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:PAFF, PT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:321-984-0706
Mailing Address - Street 1:1900 S HARBOR CITY BLVD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4749
Mailing Address - Country:US
Mailing Address - Phone:321-984-0706
Mailing Address - Fax:321-804-8003
Practice Address - Street 1:1900 S HARBOR CITY BLVD
Practice Address - Street 2:SUITE 121
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4749
Practice Address - Country:US
Practice Address - Phone:321-984-0706
Practice Address - Fax:321-804-8003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299994517251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health