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Coastal Community Health Services, Inc.

Organization Active NPI Federally Qualified Health Center (FQHC) · Savannah, GA

NPI 1992500912 · NPPES record last updated Feb 14, 2025

Key facts

NPI
1992500912
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
COASTAL COMMUNITY HEALTH SERVICES, INC.
Practice address
5772 Waters Ave
Savannah, GA 31404-6240
Phone
(912) 275-8028
NPI assigned
Feb 14, 2025
Organization subpart
No

Authorized official

Name
Kavanaugh Chandler, MD
Title
Ceo
Phone
(912) 275-8028

Other NPIs with the same Medicare PAC ID 16

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 23

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 55

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 55

Medicare participation

Medicare fee-for-service enrollment
Enrolled in GA

Federally qualified health center certification: CCN C21035

Legal name
COASTAL COMMUNITY HEALTH SERVICES INC
Doing business as
COASTAL COMMUNITY HEALTH-CITY OF SAVANNAH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 7, 2025
Last certification
Mar 7, 2025
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Enrollment address
5772 Waters Ave
Savannah, GA 31404-6240

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Faye Mathis
Individual 		Corporate Director
Board Vice Chair		 Jan 9, 2020
Kavanaugh Chandler
Individual 		Corporate Director
Ceo		 Jul 1, 2021 100%
W-2 Managing Employee
Ceo		 Jul 6, 2021 100%
Jeffery Clark
Individual 		Corporate Director
Board Treasurer		 Aug 17, 2022
Samantha Young
Individual 		Corporate Director
Board Member		 Jun 26, 2023
Josiah Watts
Individual 		Corporate Director
Board Chair		 Aug 30, 2022
D'Jon McNair
Individual 		Corporate Director
Board Member		 Jun 26, 2023

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20250321001250 GA Part a Provider - Federally Qualified Health Center (FQHC) 0345463683 Practice locations: Savannah, GA

National Provider Directory

Tax ID family
Coastal HLTH Srvcs Inc (24 organizations share this tax ID)

Locations

5772 Waters Ave
Savannah, GA 31404
Phone (912) 483-0041

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Yes

Addresses

Primary practice location

5772 Waters Ave
Savannah, GA 31404-6240

Mailing address

100 Professional Center Dr
Brunswick, GA 31525-6743
Phone (912) 275-8028

Other names

  • Coastal Community Health Doing business as

Other providers in Savannah, GA

All providers in Savannah, GA · Federally Qualified Health Center (FQHC) in Georgia

Sources for this page

Verify at the official NPI Registry.