Provider Demographics
NPI:1003459926
Name:CENTRAL COAST NON-EMERGENCY MEDICAL TRANSPORTATION LLC
Entity Type:Organization
Organization Name:CENTRAL COAST NON-EMERGENCY MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MAHAFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-364-0677
Mailing Address - Street 1:200 S 13TH ST STE 107
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-2262
Mailing Address - Country:US
Mailing Address - Phone:805-364-0677
Mailing Address - Fax:
Practice Address - Street 1:200 S 13TH ST STE 107
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-2262
Practice Address - Country:US
Practice Address - Phone:805-364-0677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)