Provider Demographics
NPI:1467593897
Name:COAST TO COAST SERVICES INC
Entity Type:Organization
Organization Name:COAST TO COAST SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NSUHODEIDEM
Authorized Official - Middle Name:
Authorized Official - Last Name:OKON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-477-4247
Mailing Address - Street 1:22435 HARPER AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1819
Mailing Address - Country:US
Mailing Address - Phone:586-863-1500
Mailing Address - Fax:586-863-1505
Practice Address - Street 1:22435 HARPER AVENUE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1819
Practice Address - Country:US
Practice Address - Phone:586-863-1500
Practice Address - Fax:586-863-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI237786Medicare Oscar/Certification