Provider Demographics
NPI:1578625992
Name:COASTAL HOME HEALTHCARE
Entity Type:Organization
Organization Name:COASTAL HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SOWASH
Authorized Official - Suffix:
Authorized Official - Credentials:BATCHLORS DEGREE SS
Authorized Official - Phone:910-392-0256
Mailing Address - Street 1:925 S KERR AVE
Mailing Address - Street 2:STE F
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4335
Mailing Address - Country:US
Mailing Address - Phone:910-392-0256
Mailing Address - Fax:910-392-0549
Practice Address - Street 1:925 S KERR AVE
Practice Address - Street 2:STE F
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4335
Practice Address - Country:US
Practice Address - Phone:910-392-0256
Practice Address - Fax:910-392-0549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2551251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601118Medicaid
NC3408407Medicaid