Provider Demographics
NPI:1952936981
Name:COAST 2 COAST HOME CARE AGENCY
Entity Type:Organization
Organization Name:COAST 2 COAST HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:BHA, MPA, MA, CSCM
Authorized Official - Phone:888-465-3692
Mailing Address - Street 1:15255 S 94TH AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3895
Mailing Address - Country:US
Mailing Address - Phone:888-465-3692
Mailing Address - Fax:888-465-3692
Practice Address - Street 1:15255 S 94TH AVE STE 500
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3895
Practice Address - Country:US
Practice Address - Phone:888-465-3692
Practice Address - Fax:888-465-3692
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAYLORMADE STAFFING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care