Provider Demographics
NPI:1124896196
Name:COASTAL CARE LLC
Entity type:Organization
Organization Name:COASTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KAMIL
Authorized Official - Middle Name:AWEIS
Authorized Official - Last Name:SUJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-202-2400
Mailing Address - Street 1:75 BISHOP ST # 13
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2614
Mailing Address - Country:US
Mailing Address - Phone:408-202-2400
Mailing Address - Fax:
Practice Address - Street 1:75 BISHOP ST # 13
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2614
Practice Address - Country:US
Practice Address - Phone:408-202-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care