Provider Demographics
NPI:1770602278
Name:COASTLINE ELDERLY SERVICES, INC.
Entity type:Organization
Organization Name:COASTLINE ELDERLY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECOTR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:SISSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-999-6400
Mailing Address - Street 1:1646 PURCHASE ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-6819
Mailing Address - Country:US
Mailing Address - Phone:508-999-6400
Mailing Address - Fax:508-993-6510
Practice Address - Street 1:1646 PURCHASE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-6819
Practice Address - Country:US
Practice Address - Phone:508-999-6400
Practice Address - Fax:508-993-6510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1948504OtherPROVIDER NUMBER