Provider Demographics
NPI:1902340441
Name:COASTAL HOME HEALTH
Entity Type:Organization
Organization Name:COASTAL HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:LUNDIN
Authorized Official - Suffix:
Authorized Official - Credentials:AEMT
Authorized Official - Phone:207-610-1534
Mailing Address - Street 1:291 MORGAN BAY RD
Mailing Address - Street 2:
Mailing Address - City:SURRY
Mailing Address - State:ME
Mailing Address - Zip Code:04684-3612
Mailing Address - Country:US
Mailing Address - Phone:207-610-1534
Mailing Address - Fax:
Practice Address - Street 1:291 MORGAN BAY RD
Practice Address - Street 2:
Practice Address - City:SURRY
Practice Address - State:ME
Practice Address - Zip Code:04684-3612
Practice Address - Country:US
Practice Address - Phone:207-610-1534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health