Provider Demographics
NPI:1073064234
Name:COMFORT CARE COASTAL HOME HEALTH
Entity type:Organization
Organization Name:COMFORT CARE COASTAL HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICARE BILLINGA ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:OVETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-988-4879
Mailing Address - Street 1:374 GREENO RD S
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-1916
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:374 GREENO RD S
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1916
Practice Address - Country:US
Practice Address - Phone:205-988-4879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1740653047Medicare UPIN