Healthcare Provider Details

I. General information

NPI: 1548449879
Provider Name (Legal Business Name): TRI-COASTAL MANAGEMENT GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 N FERN AVE
HIGHLAND SPRINGS VA
23075-1441
US

IV. Provider business mailing address

PO BOX 2292
CHESTER VA
23831-8444
US

V. Phone/Fax

Practice location:
  • Phone: 804-680-3013
  • Fax: 804-545-3901
Mailing address:
  • Phone: 804-680-3013
  • Fax: 804-545-3901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateVA

VIII. Authorized Official

Name: MR. RODNEY DINEZ-CATRALLE BARNES
Title or Position: PRES/CEO
Credential:
Phone: 804-680-3013