Provider Demographics
NPI:1316316037
Name:PRIORITY COASTAL CARE LLC
Entity type:Organization
Organization Name:PRIORITY COASTAL CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:TREMBLAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-483-9111
Mailing Address - Street 1:800 PINEBROOK RD
Mailing Address - Street 2:SUITE 812
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-7103
Mailing Address - Country:US
Mailing Address - Phone:941-483-9111
Mailing Address - Fax:941-237-4122
Practice Address - Street 1:800 PINEBROOK RD
Practice Address - Street 2:SUITE 812
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-7103
Practice Address - Country:US
Practice Address - Phone:941-483-9111
Practice Address - Fax:941-237-4122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health