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Organization
COAST HEALTHCARE SUPPLY
Active
Organization
COAST HEALTHCARE SUPPLY
Active
Other names
Karen Markard Jenkins
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANE DAHL (MANAGER)
(707) 964-1112
Entity
Organization
Contact information
Practice address
190 E ELM ST, FORT BRAGG, CA 95437-3026
(707) 964-1112
(707) 964-1222
Mailing address
190 E ELM ST, P.O. BOX 1330, FORT BRAGG, CA 95437-3026
(707) 964-1112
(707) 964-1222
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
102629
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DME1708F
—
CA
Enumeration date
10/25/2006
Last updated
08/22/2020
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