Organization
COASTAL HOME CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH BONACCORSI (CHIEF LEGAL OFFICER)
(312) 962-9999
Entity
Organization
Contact information
Practice address
777 GLOUCESTER ST STE 300, BRUNSWICK, GA 31520-7068
(912) 264-5363
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
063-R-0272
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000552538AK
—
GA
Enumeration date
01/25/2012
Last updated
04/29/2025
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