Provider Demographics
NPI:1538264882
Name:COASTAL HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:COASTAL HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-419-4994
Mailing Address - Street 1:6320 SAINT AUGUSTINE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2800
Mailing Address - Country:US
Mailing Address - Phone:904-419-4994
Mailing Address - Fax:904-419-4990
Practice Address - Street 1:6320 SAINT AUGUSTINE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2800
Practice Address - Country:US
Practice Address - Phone:904-419-4994
Practice Address - Fax:904-419-4990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108165Medicare ID - Type UnspecifiedHOME HEALTH AGENCY