Provider Demographics
NPI:1679288427
Name:INNERCOASTAL HOME CARE SERVICES, INC
Entity type:Organization
Organization Name:INNERCOASTAL HOME CARE SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERSAUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-642-5345
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:COLERAIN
Mailing Address - State:NC
Mailing Address - Zip Code:27924-0134
Mailing Address - Country:US
Mailing Address - Phone:252-642-5345
Mailing Address - Fax:
Practice Address - Street 1:301 MAIN ST W STE 2
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3319
Practice Address - Country:US
Practice Address - Phone:252-642-5345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-17
Last Update Date:2023-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care