Provider Demographics
NPI:1407459308
Name:COASTAL HOSPICE INC
Entity Type:Organization
Organization Name:COASTAL HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-512-5041
Mailing Address - Street 1:PO BOX 6042
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-0137
Mailing Address - Country:US
Mailing Address - Phone:707-460-6191
Mailing Address - Fax:866-611-8843
Practice Address - Street 1:786 H ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-3748
Practice Address - Country:US
Practice Address - Phone:707-460-6191
Practice Address - Fax:866-611-8843
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COASTAL HOME HEALTH & HOSPICE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-21
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based