Provider Demographics
NPI:1932717238
Name:COAST TO COAST HEALTHCARE SOLUTIONS, INC.
Entity Type:Organization
Organization Name:COAST TO COAST HEALTHCARE SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN
Authorized Official - Phone:305-999-9295
Mailing Address - Street 1:900 NW 13TH ST STE 302-1
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2335
Mailing Address - Country:US
Mailing Address - Phone:305-999-9295
Mailing Address - Fax:305-999-9259
Practice Address - Street 1:900 NW 13TH ST STE 302-1
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2335
Practice Address - Country:US
Practice Address - Phone:305-999-9295
Practice Address - Fax:305-999-9259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108375300Medicaid
FL687228001Medicaid
FL687228096OtherMEDICAID WAIVER
FL687228003Medicaid
FL687228004OtherMEDICAID WAIVER
FL687228006Medicaid