| Organization Name: | COASTAL CAROLINA RESPIRATORY SERVICES, INC |
| NPI Number: | 1992858237 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LISA KELLY PICKETT (PRESIDENT OWNER) |
| Mailing Address: | 106 S. Brown Road Beulaville |
| State: | NC US |
| Postal Code: | 285180467 |
| Phone Number: | 9199208916 |
| Fax Number: | |
| NPI Enumeration Date: | 01/19/2007 |
| NPI Last Update Date: | 03/26/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BN1400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Nursing Facility Supplies |
| Taxonomy Definition: | |