Provider Demographics
NPI:1285705442
Name:GULF COAST COMMUNITY HEALTH SERVICES, INC
Entity type:Organization
Organization Name:GULF COAST COMMUNITY HEALTH SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KINGSLEY
Authorized Official - Middle Name:EZE
Authorized Official - Last Name:AGBOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-484-2727
Mailing Address - Street 1:17223 MERCURY DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2733
Mailing Address - Country:US
Mailing Address - Phone:281-484-2727
Mailing Address - Fax:281-464-7090
Practice Address - Street 1:17223 MERCURY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2733
Practice Address - Country:US
Practice Address - Phone:281-484-2727
Practice Address - Fax:281-464-7090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX006529251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1686032Medicaid
TX459448Medicare ID - Type UnspecifiedMEDICRE