Provider Demographics
NPI:1427899673
Name:COASTAL COMFORT NEMT LLC
Entity type:Organization
Organization Name:COASTAL COMFORT NEMT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:B
Authorized Official - Last Name:SALLOUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-616-3460
Mailing Address - Street 1:304 SWEETBRIER BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259
Mailing Address - Country:US
Mailing Address - Phone:904-616-3460
Mailing Address - Fax:
Practice Address - Street 1:6401 WILSON BLVD.
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210
Practice Address - Country:US
Practice Address - Phone:904-616-3460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)