Organization
COASTAL HOME CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH BONACCCORSI (CHIEF LEGAL OFFICER)
(312) 762-9999
Entity
Organization
Contact information
Practice address
1431 CAPITAL AVE STE 111, WATKINSVILLE, GA 30677-1883
(706) 850-1871
Mailing address
33 S STATE ST FL 5, CHICAGO, IL 60603-2804
(312) 762-9999
(912) 352-9601
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
—
000498242B
—
GA
Enumeration date
01/25/2012
Last updated
04/29/2025
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