Provider Demographics
NPI:1972565380
Name:COASTAL HOME CARE, INC.
Entity Type:Organization
Organization Name:COASTAL HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-638-7638
Mailing Address - Street 1:4700 140TH AVE N STE C102
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-3846
Mailing Address - Country:US
Mailing Address - Phone:727-576-2040
Mailing Address - Fax:727-576-2050
Practice Address - Street 1:4700 140TH AVE N STE C102
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-3846
Practice Address - Country:US
Practice Address - Phone:727-576-2040
Practice Address - Fax:727-576-2050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA299991953251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108109Medicare ID - Type UnspecifiedPROVIDER #