Provider Demographics
NPI:1346129269
Name:COASTAL CARE HOME LLC
Entity type:Organization
Organization Name:COASTAL CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:KELVIN
Authorized Official - Last Name:LAMB
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:757-775-3731
Mailing Address - Street 1:318 WINDEMERE RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-6100
Mailing Address - Country:US
Mailing Address - Phone:757-775-3731
Mailing Address - Fax:
Practice Address - Street 1:226 MENCHVILLE RD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-6848
Practice Address - Country:US
Practice Address - Phone:757-775-3731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No177F00000XOther Service ProvidersLodging
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care