Provider Demographics
NPI:1538144712
Name:COASTAL HOME RESPIRATORY LLP
Entity Type:Organization
Organization Name:COASTAL HOME RESPIRATORY LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HENDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-925-5572
Mailing Address - Street 1:409 E MONTGOMERY XRD
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4908
Mailing Address - Country:US
Mailing Address - Phone:912-925-5572
Mailing Address - Fax:912-925-5507
Practice Address - Street 1:409 E MONTGOMERY XRD
Practice Address - Street 2:SUITE 5A
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4908
Practice Address - Country:US
Practice Address - Phone:912-925-5572
Practice Address - Fax:912-925-5507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-12
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000755422AMedicaid
GA000755422AMedicaid