Provider Demographics
NPI:1700101623
Name:COASTAL CARE HOME MEDICAL, INC
Entity type:Organization
Organization Name:COASTAL CARE HOME MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-417-3373
Mailing Address - Street 1:1055 N DIXIE FWY
Mailing Address - Street 2:SUITE 7
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-6201
Mailing Address - Country:US
Mailing Address - Phone:407-417-3373
Mailing Address - Fax:
Practice Address - Street 1:1055 N DIXIE FWY
Practice Address - Street 2:SUITE 7
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-6201
Practice Address - Country:US
Practice Address - Phone:407-417-3373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-03
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies