Provider Demographics
NPI:1598828436
Name:COASTAL KIDS HOME CARE
Entity Type:Organization
Organization Name:COASTAL KIDS HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:800-214-5439
Mailing Address - Street 1:1172 S MAIN ST # 125
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2204
Mailing Address - Country:US
Mailing Address - Phone:800-214-5439
Mailing Address - Fax:831-796-0334
Practice Address - Street 1:1020 MERRILL ST
Practice Address - Street 2:SUITE 2015
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4495
Practice Address - Country:US
Practice Address - Phone:800-214-5439
Practice Address - Fax:831-796-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA70312FMedicaid