Provider Demographics
NPI:1124468186
Name:D M & D COASTAL INVESTMENTS LLC
Entity type:Organization
Organization Name:D M & D COASTAL INVESTMENTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCKELVAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-497-6908
Mailing Address - Street 1:1497 A CREIGHTON ROAD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504
Mailing Address - Country:US
Mailing Address - Phone:850-497-6908
Mailing Address - Fax:850-497-6741
Practice Address - Street 1:1497 A CREIGHTON ROAD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504
Practice Address - Country:US
Practice Address - Phone:850-497-6908
Practice Address - Fax:850-497-6741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-04
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL253Z00000X
FL30211679253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care