Organization
COASTAL HOME CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH BONACCORSI (CHIEF LEGAL OFFICER)
(312) 762-9999
Entity
Organization
Contact information
Practice address
6602 ABERCORN ST STE 200, SAVANNAH, GA 31405-5849
(912) 354-3680
Mailing address
33 S STATE ST FL 5, CHICAGO, IL 60603-2804
(312) 762-9999
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
025-R-0271
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000552538B
—
GA
Enumeration date
01/25/2012
Last updated
10/07/2022
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