Provider Demographics
NPI:1720356769
Name:COAST LINE INFUSION, INC.
Entity Type:Organization
Organization Name:COAST LINE INFUSION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:T
Authorized Official - Last Name:TINDELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:818-652-8000
Mailing Address - Street 1:1020 N HOLLYWOOD WAY
Mailing Address - Street 2:NO 10
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-2525
Mailing Address - Country:US
Mailing Address - Phone:818-652-8000
Mailing Address - Fax:
Practice Address - Street 1:1020 N HOLLYWOOD WAY
Practice Address - Street 2:NO 10
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-2525
Practice Address - Country:US
Practice Address - Phone:818-652-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion