Healthcare Provider Details

I. General information

NPI: 1740757210
Provider Name (Legal Business Name): COAST GROUP TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11474 PATTERSON LN
ELBERTA AL
36530-4670
US

IV. Provider business mailing address

11474 PATTERSON LN
ELBERTA AL
36530-4670
US

V. Phone/Fax

Practice location:
  • Phone: 251-752-0681
  • Fax:
Mailing address:
  • Phone: 251-752-0681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: JON JONES
Title or Position: CEO
Credential:
Phone: 251-752-0681