Provider Demographics
NPI:1407932643
Name:COASTAL HOSPICE, INC.
Entity Type:Organization
Organization Name:COASTAL HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARION
Authorized Official - Middle Name:F
Authorized Official - Last Name:KEENAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MBA
Authorized Official - Phone:410-742-8732
Mailing Address - Street 1:PO BOX 1733
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-1733
Mailing Address - Country:US
Mailing Address - Phone:410-742-8732
Mailing Address - Fax:410-548-5080
Practice Address - Street 1:2604 OLD OCEAN CITY RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-4629
Practice Address - Country:US
Practice Address - Phone:410-742-8732
Practice Address - Fax:410-548-5080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDHH7062251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========OtherHOME HEALTH
MD=========OtherHOME HEALTH