Provider Demographics
NPI:1457353765
Name:COASTAL HOSPICE CARE, INC.
Entity Type:Organization
Organization Name:COASTAL HOSPICE CARE, INC.
Other - Org Name:COASTAL HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MONTE
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-675-0012
Mailing Address - Street 1:90 MCKEOUGH AVE
Mailing Address - Street 2:
Mailing Address - City:SARALAND
Mailing Address - State:AL
Mailing Address - Zip Code:36571-3227
Mailing Address - Country:US
Mailing Address - Phone:251-675-0012
Mailing Address - Fax:251-675-3303
Practice Address - Street 1:90 MCKEOUGH AVE
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-3227
Practice Address - Country:US
Practice Address - Phone:251-675-0012
Practice Address - Fax:251-675-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11164251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL01-1627Medicare ID - Type UnspecifiedPROVIDER NUMBER