Provider Demographics
NPI:1649817263
Name:COASTAL HEARING CARE, INC
Entity type:Organization
Organization Name:COASTAL HEARING CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:DESERMIA
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:941-229-2122
Mailing Address - Street 1:5860 RANCH LAKE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-3719
Mailing Address - Country:US
Mailing Address - Phone:941-229-2122
Mailing Address - Fax:941-757-3732
Practice Address - Street 1:5860 RANCH LAKE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-3719
Practice Address - Country:US
Practice Address - Phone:941-229-2122
Practice Address - Fax:941-757-3732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Multi-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech