Basic Information
Provider Information
NPI: 1205209509
EntityType: 2
ReplacementNPI:  
OrganizationName: COMFORT CARE COASTAL HOSPICE, LLC
LastName:  
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Credential:  
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Mailing Information
Address1: 245 CAHABA VALLEY PKWY
Address2: SUITE 200
City: PELHAM
State: AL
PostalCode: 351242216
CountryCode: US
TelephoneNumber: 2059426820
FaxNumber:  
Practice Location
Address1: 22502 U.S. HIGHWAY 98
Address2:  
City: FAIRHOPE
State: AL
PostalCode: 36532
CountryCode: US
TelephoneNumber: 2059426820
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/09/2015
LastUpdateDate: 10/24/2016
NPIDeactivationReasonCode:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: FRANKLIN
AuthorizedOfficialFirstName: MARTY
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 2059426820
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251G00000XE4903ALY AgenciesHospice Care, Community Based 

ID Information
IDTypeStateIssuerDescription
PIC1502E05AL MEDICAID


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