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
3470 N VALDOSTA RD STE B, VALDOSTA, GA 31602-1050
(229) 671-9232
Mailing address
33 S STATE ST FL 5, CHICAGO, IL 60603-2804
(312) 762-9999
(912) 355-8738
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
016R0270
GA
251E00000X
Home Health Agency
025R0271
GA
251E00000X
Home Health Agency
063R0272
GA
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000609958P
—
GA
Enumeration date
02/15/2007
Last updated
04/29/2025
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