Provider Demographics
NPI:1215938535
Name:GULF COAST VILLAGE HOME HEALTH
Entity type:Organization
Organization Name:GULF COAST VILLAGE HOME HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIR. OF HOME & COMM BASED SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:239-772-7480
Mailing Address - Street 1:1435 SANTA BARBARA BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-2842
Mailing Address - Country:US
Mailing Address - Phone:239-772-7480
Mailing Address - Fax:
Practice Address - Street 1:1435 SANTA BARBARA BLVD STE 1
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-2842
Practice Address - Country:US
Practice Address - Phone:239-772-7480
Practice Address - Fax:239-772-7980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA29991969251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108114Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER