Provider Demographics
NPI:1720439904
Name:COASTAL LIVING HOME HEALTH LLC
Entity Type:Organization
Organization Name:COASTAL LIVING HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BLISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-335-8441
Mailing Address - Street 1:200 S 13TH ST
Mailing Address - Street 2:SUITE 211 & 212
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-3302
Mailing Address - Country:US
Mailing Address - Phone:805-335-8441
Mailing Address - Fax:805-980-5705
Practice Address - Street 1:200 S 13TH ST
Practice Address - Street 2:SUITE 211 & 212
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-3302
Practice Address - Country:US
Practice Address - Phone:805-335-8441
Practice Address - Fax:805-980-5705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health