- Enrollment id
- O20030825000002
- Enrollment state
- TX
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1144305004
- Multiple npi flag
- N
- Ccn
- 678086
- Associate id
- 4688585029
- Organization name
- COASTAL MEDICAL SERVICES INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 7070 KNIGHTS CT
- Address line 2
- STE 604
- City
- MISSOURI CITY
- State
- TX
- Zip code
- 774595229