Provider Demographics
NPI:1740221043
Name:COASTAL HOME HEALTH INC
Entity Type:Organization
Organization Name:COASTAL HOME HEALTH INC
Other - Org Name:COASTAL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:ARMENDA
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:409-835-1518
Mailing Address - Street 1:3515 FANNIN ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-3815
Mailing Address - Country:US
Mailing Address - Phone:409-835-1518
Mailing Address - Fax:409-835-1164
Practice Address - Street 1:3515 FANNIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3815
Practice Address - Country:US
Practice Address - Phone:409-835-1518
Practice Address - Fax:409-835-1164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007283251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX017307201Medicaid
TX024442801Medicaid
TX679000Medicare Oscar/Certification