Provider Demographics
NPI:1528524840
Name:COASTAL HOME HEALTH & REJUVENATION
Entity type:Organization
Organization Name:COASTAL HOME HEALTH & REJUVENATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:FOOTIT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:267-559-5985
Mailing Address - Street 1:509 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH WILDWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08260-5842
Mailing Address - Country:US
Mailing Address - Phone:267-559-5985
Mailing Address - Fax:
Practice Address - Street 1:509 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:NORTH WILDWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08260-5842
Practice Address - Country:US
Practice Address - Phone:267-559-5985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health