Provider Demographics
NPI:1730284225
Name:COAST LIFE SUPPORT DISTRICT
Entity Type:Organization
Organization Name:COAST LIFE SUPPORT DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-884-1829
Mailing Address - Street 1:PO BOX 269110
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-9110
Mailing Address - Country:US
Mailing Address - Phone:916-669-4607
Mailing Address - Fax:916-471-5107
Practice Address - Street 1:38901 OCEAN DRIVE
Practice Address - Street 2:
Practice Address - City:GUALALA
Practice Address - State:CA
Practice Address - Zip Code:95445-8001
Practice Address - Country:US
Practice Address - Phone:707-884-1829
Practice Address - Fax:707-884-4663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ17652ZMedicare ID - Type Unspecified