Provider Demographics
NPI:1316209927
Name:COASTLINE TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:COASTLINE TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE MEMBER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-B
Authorized Official - Phone:231-398-0360
Mailing Address - Street 1:PO BOX 372
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-0372
Mailing Address - Country:US
Mailing Address - Phone:231-398-0360
Mailing Address - Fax:360-285-8130
Practice Address - Street 1:1101 25TH ST
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-2401
Practice Address - Country:US
Practice Address - Phone:231-398-0360
Practice Address - Fax:360-285-8130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-10
Last Update Date:2012-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)