Provider Demographics
NPI:1194082917
Name:GULF COUNTY SENIOR CITIZENS ASSOCIATION, INC
Entity type:Organization
Organization Name:GULF COUNTY SENIOR CITIZENS ASSOCIATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-229-8466
Mailing Address - Street 1:120 LIBRARY DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32456-1650
Mailing Address - Country:US
Mailing Address - Phone:850-229-8466
Mailing Address - Fax:850-227-1877
Practice Address - Street 1:120 LIBRARY DR
Practice Address - Street 2:
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-1650
Practice Address - Country:US
Practice Address - Phone:850-229-8466
Practice Address - Fax:850-227-1877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5895253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL670698300Medicaid
FL679633800Medicaid