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General NPI Number Information
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NPI Number | 1285671172
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Entity Type | Organization
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Legal Business Name | COASTLINE VOLUNTEER RESCUE SQUAD
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3027 HOLDEN BEACH RD SW
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City | SUPPLY
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State | NC
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Zip | 28462-5709
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Country | US
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Telephone | 910-842-2266
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Fax | 910-846-2251
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Provider Business Mailing Address
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Address Line | PO BOX 24
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City | SUPPLY
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State | NC
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Zip | 28462-0024
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Country | US
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Telephone | 910-842-2266
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Fax | 910-846-2251
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. PINTA B TODD
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Credential |
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Telephone | 910-842-2266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State | NC
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