Provider Demographics
NPI:1194406124
Name:COQUINA COVE HOME HEALTH LLC
Entity type:Organization
Organization Name:COQUINA COVE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATION
Authorized Official - Prefix:MS
Authorized Official - First Name:ABIOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-550-2211
Mailing Address - Street 1:10957 LEDGEMENT LN
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6423
Mailing Address - Country:US
Mailing Address - Phone:240-550-2211
Mailing Address - Fax:
Practice Address - Street 1:4700 MILLENIA BLVD STE 500
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-6019
Practice Address - Country:US
Practice Address - Phone:240-550-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health