NPIMap

Organization Active NPI

Coastal Health, LLC

  • Home Health Agency
  • Florence, SC
National Provider Identifier
1518508050
Registry record updated Jun 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
COASTAL HEALTH, LLC
Practice address
130 1/2 S Irby St
Florence, SC 29501-4410
Phone
(843) 407-7413
Fax
(843) 407-7987
NPI assigned
Oct 7, 2019
Last updated
Jun 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2022

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

Authorized official

Name
William Jeffrey Poole
Title
Owner/President
Phone
(843) 229-0029

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NU Primary

Addresses

Primary practice location

130 1/2 S Irby St
Florence, SC 29501-4410

Mailing address

130 1/2 S Irby St
Florence, SC 29501-4410

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200724002779 SC Part A Provider - Home Health Agency 4385068196 Practice locations: Florence, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1518508050. Details of each certification follow.

Home health agency certification: CCN 427142

Legal name
COASTAL HEALTH LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Dec 26, 2020
Last certification
Dec 26, 2020
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Mar 22, 2018
Enrollment address
2420 Hoffmeyer Rd
Ste C
Florence, SC 29501-7426

Care Compare: Home health agency

Medicare Care Compare
Listed as
Coastal Health LLCCCN 427142 · All quality measures
Overall star rating
4.5 of 5
Ownership
Proprietary
Certified
Dec 26, 2020
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D2182343Coastal Health, LLC2420 Hoffmeyer Road, Suite C, Florence, SC 29501Certificate of waiverApr 19, 2028

National Provider Directory

National Provider Directory

Locations

130 S Irby St
Florence, SC 29501
Phone (843) 407-7413

2420 Hoffmeyer Rd
Unit C
Florence, SC 29501
Phone (843) 407-7413

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
William Poole Individual 5% Or Greater Direct Ownership Interest Mar 22, 2018 100%
Corporate DirectorBoard Member President Treasurer Mar 22, 2018 50%
W-2 Managing EmployeeBoard Member President Treasurer Mar 22, 2018 50%

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 17

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1570406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655942400000",
    "number": "1518508050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 1/2 S IRBY ST",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295014410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 1/2 S IRBY ST",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295014410",
            "telephone_number": "843-407-7413",
            "fax_number": "843-407-7987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-07",
        "last_updated": "2022-06-23",
        "certification_date": "2022-06-23",
        "status": "A",
        "authorized_official_last_name": "POOLE",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "843-229-0029"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Florence, SC

Sources for this page

Verify at the official NPI Registry.