Provider Demographics
NPI:1598797078
Name:COASTAL STAFF RELIEF, INC.
Entity Type:Organization
Organization Name:COASTAL STAFF RELIEF, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:979-549-2849
Mailing Address - Street 1:1029 DIXIE DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLUTE
Mailing Address - State:TX
Mailing Address - Zip Code:77531
Mailing Address - Country:US
Mailing Address - Phone:979-299-3006
Mailing Address - Fax:979-299-3113
Practice Address - Street 1:1029 DIXIE DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:CLUTE
Practice Address - State:TX
Practice Address - Zip Code:77531
Practice Address - Country:US
Practice Address - Phone:979-299-3006
Practice Address - Fax:979-299-3113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009576251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH467HOtherBLUE CROSS BLUE SHIELD
TX178769901Medicaid
TXHH467HOtherBLUE CROSS BLUE SHIELD