Provider Demographics
NPI:1912286386
Name:COASTAL HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:COASTAL HEALTH SERVICES, INC
Other - Org Name:CONFICARE HOME HEALTH SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-315-1724
Mailing Address - Street 1:1515 ORMSBY STATION CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4019
Mailing Address - Country:US
Mailing Address - Phone:502-315-1720
Mailing Address - Fax:
Practice Address - Street 1:1275 W GRANADA BLVD
Practice Address - Street 2:STE 6B
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8259
Practice Address - Country:US
Practice Address - Phone:386-492-6612
Practice Address - Fax:386-492-6600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-16
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health