Provider Demographics
NPI:1770995821
Name:COAST REHABILITATION SERVICES
Entity type:Organization
Organization Name:COAST REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-861-3372
Mailing Address - Street 1:PO BOX 760
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146-0760
Mailing Address - Country:US
Mailing Address - Phone:503-861-3372
Mailing Address - Fax:503-861-3476
Practice Address - Street 1:89451 HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146-7105
Practice Address - Country:US
Practice Address - Phone:503-861-3372
Practice Address - Fax:503-861-3476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty