NPIMap

Organization Active NPI

Coastal Plains Home Health Agency 9a

  • Home Health Agency
  • Gulfport, MS
National Provider Identifier
1336124270
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
3481 Issued in MS
Legal business name
COASTAL PLAINS HOME HEALTH AGENCY 9A
Practice address
1102 45TH Ave
Gulfport, MS 39501-2504
Phone
(228) 867-6115
Fax
(228) 867-6185
NPI assigned
Dec 14, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Mitchell Adcock, CPA CIA CFE
Title
Director of Finance Administration
Phone
(601) 576-7853

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 3481 MS Primary

Addresses

Primary practice location

1102 45TH Ave
Gulfport, MS 39501-2504

Mailing address

1102 45TH Ave
Gulfport, MS 39501-2504
Phone (228) 867-6115

Other identifiers 1

IdentifierTypeStateIssuer
00070500MedicaidMS

National Provider Directory

National Provider Directory
Tax ID family
Mississippi Department Health126 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

1102 45th Ave
Gulfport, MS 39501
Phone (228) 863-1036

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1336124270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1102 45TH AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012504",
            "telephone_number": "228-867-6115",
            "fax_number": "228-867-6185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 45TH AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012504",
            "telephone_number": "228-867-6115",
            "fax_number": "228-867-6185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL PLAINS HOME HEALTH AGENCY 9A",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ADCOCK",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE ADMINISTRATION",
        "authorized_official_telephone_number": "601-576-7853",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA CIA CFE"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MS",
            "license": "3481",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00070500",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.