Provider Demographics
NPI:1083709984
Name:COASTAL HOSPICE INC
Entity type:Organization
Organization Name:COASTAL HOSPICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BELANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-742-8732
Mailing Address - Street 1:PO BOX 1733
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-1733
Mailing Address - Country:US
Mailing Address - Phone:410-742-8732
Mailing Address - Fax:410-543-8213
Practice Address - Street 1:1113 HEALTHWAY DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-4470
Practice Address - Country:US
Practice Address - Phone:410-742-8732
Practice Address - Fax:410-543-8213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH1505251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD536295403Medicaid
MDMH8OtherHOSPICE
MD02SGOtherHOSPICE
MD139353700Medicaid
MDMH4OtherHOSPICE
MDMH4OtherHOSPICE
MD139353700Medicaid