Provider Demographics
NPI:1437128386
Name:COASTLINE CARE INC
Entity Type:Organization
Organization Name:COASTLINE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:7577-655-0029
Mailing Address - Street 1:PO BOX 538330
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-8330
Mailing Address - Country:US
Mailing Address - Phone:866-343-7153
Mailing Address - Fax:757-787-9436
Practice Address - Street 1:124 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28466-2902
Practice Address - Country:US
Practice Address - Phone:866-343-7153
Practice Address - Fax:757-787-9436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15223416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0720COtherBCBS
NC3406665Medicaid
NC590011105OtherRAILROAD MEDICARE
NC2782524Medicare ID - Type Unspecified