Organization Name: | COASTAL HOME REHABILITATION, LLC |
NPI Number: | 1316236664 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRIAN LOVE (PARTNER) |
Mailing Address: | 508 10th Ave Belmar |
State: | NJ US |
Postal Code: | 077192317 |
Phone Number: | 9086706695 |
Fax Number: | |
NPI Enumeration Date: | 04/06/2011 |
NPI Last Update Date: | 04/06/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM1300X |
License Number: | QA00884600 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Multi-Specialty |
Taxonomy Definition: |