Provider Demographics
NPI:1558392209
Name:COASTAL HOME CARE SERVICES, INC.
Entity Type:Organization
Organization Name:COASTAL HOME CARE SERVICES, INC.
Other - Org Name:CHOICE HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:O'SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:209-524-8700
Mailing Address - Street 1:3340 TULLY RD
Mailing Address - Street 2:SUITE C-8A
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0838
Mailing Address - Country:US
Mailing Address - Phone:209-524-8700
Mailing Address - Fax:209-524-8701
Practice Address - Street 1:80 GARDEN CT
Practice Address - Street 2:SUITE 105
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5367
Practice Address - Country:US
Practice Address - Phone:831-645-1400
Practice Address - Fax:831-657-1996
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REHABFOCUS HOME HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-05
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
CA0700000367251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA574061GMedicaid
CA55-7461Medicare UPIN