Provider Demographics
NPI:1497515571
Name:COASTAL COMPANION CARE, LLC
Entity Type:Organization
Organization Name:COASTAL COMPANION CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:HAVILAND
Authorized Official - Last Name:BUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-742-9108
Mailing Address - Street 1:P.O. BOX 297
Mailing Address - Street 2:
Mailing Address - City:OAK ISLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28465
Mailing Address - Country:US
Mailing Address - Phone:443-742-9108
Mailing Address - Fax:910-457-5333
Practice Address - Street 1:5121 SOUTHPORT SUPPLY RD SE
Practice Address - Street 2:SUITE 3
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461
Practice Address - Country:US
Practice Address - Phone:910-457-5300
Practice Address - Fax:910-457-5333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care