Provider Demographics
NPI:1285671172
Name:COASTLINE VOLUNTEER RESCUE SQUAD
Entity Type:Organization
Organization Name:COASTLINE VOLUNTEER RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PINTA
Authorized Official - Middle Name:B
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-842-2266
Mailing Address - Street 1:PO BOX 24
Mailing Address - Street 2:
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-0024
Mailing Address - Country:US
Mailing Address - Phone:910-842-2266
Mailing Address - Fax:910-846-2251
Practice Address - Street 1:3027 HOLDEN BEACH RD SW
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-5709
Practice Address - Country:US
Practice Address - Phone:910-842-2266
Practice Address - Fax:910-846-2251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406685Medicaid
NC2782423Medicare ID - Type Unspecified