Provider Demographics
NPI:1770009623
Name:COASTAL HOME CARE SERVICES INC
Entity Type:Organization
Organization Name:COASTAL HOME CARE SERVICES INC
Other - Org Name:CHOICE PERSONAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-349-1222
Mailing Address - Street 1:27071 ALISO CREEK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5325
Mailing Address - Country:US
Mailing Address - Phone:949-349-1287
Mailing Address - Fax:
Practice Address - Street 1:80 GARDEN CT STE 105B
Practice Address - Street 2:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COASTAL HOME CARE SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA274700017253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care