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
2970 CLAIRMONT RD NE STE 305, BROOKHAVEN, GA 30329-1638
(770) 376-3133
Mailing address
33 S STATE ST FL 5, CHICAGO, IL 60603-2804
(312) 762-9999
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
085-R-1045
GA
253Z00000X
In Home Supportive Care Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000552538CA
—
GA
05
—
003228727B
—
GA
01
—
PHCP010607
PERMIT
GA
Enumeration date
07/15/2013
Last updated
05/08/2025
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