Provider Demographics
NPI:1508160136
Name:COASTAL BAY HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:COASTAL BAY HEALTH SERVICES LLC
Other - Org Name:COASTAL BAY HEALTH SERVICES LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:THORPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-414-7504
Mailing Address - Street 1:10151 DEERWOOD PARK BLVD BLDG 200
Mailing Address - Street 2:SUITE 250
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0566
Mailing Address - Country:US
Mailing Address - Phone:336-414-7504
Mailing Address - Fax:
Practice Address - Street 1:10151 DEERWOOD PARK BLVD BLDG 200
Practice Address - Street 2:SUITE 250
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0566
Practice Address - Country:US
Practice Address - Phone:336-414-7504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health