Organization
COASTLINE CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW ELLIS (AR MANAGER)
75776550029
Entity
Organization
Contact information
Practice address
124 W MAIN ST, WALLACE, NC 28466-2902
(866) 343-7153
(757) 787-9436
Mailing address
PO BOX 538330, ATLANTA, GA 30353-8330
(866) 343-7153
(757) 787-9436
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
1522
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0720C
BCBS
NC
05
—
3406665
—
NC
01
—
590011105
RAILROAD MEDICARE
NC
Enumeration date
03/14/2006
Last updated
08/28/2012
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