Provider Demographics
NPI:1780283804
Name:COASTAL COMPANION CARE, LLC
Entity type:Organization
Organization Name:COASTAL COMPANION CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DINAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-505-7957
Mailing Address - Street 1:2131 HOLLYWOOD BLVD STE 503
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6753
Mailing Address - Country:US
Mailing Address - Phone:954-505-7957
Mailing Address - Fax:954-744-7408
Practice Address - Street 1:2131 HOLLYWOOD BLVD STE 503
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6753
Practice Address - Country:US
Practice Address - Phone:954-505-7957
Practice Address - Fax:954-744-7408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP230-170-61-509-0OtherHOME CARE