Provider Demographics
NPI:1386024719
Name:GULF COAST HOMECARE LLC DBA FIRSTLIGHT HOMECARE OF MOBILE EASTERN SHOR
Entity type:Organization
Organization Name:GULF COAST HOMECARE LLC DBA FIRSTLIGHT HOMECARE OF MOBILE EASTERN SHOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:ETHRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-281-2004
Mailing Address - Street 1:2315 N COUNTRY CLUB LN
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-3205
Mailing Address - Country:US
Mailing Address - Phone:228-297-0233
Mailing Address - Fax:251-206-6366
Practice Address - Street 1:5601 NEVIUS RD STE B
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36619-3901
Practice Address - Country:US
Practice Address - Phone:251-281-2004
Practice Address - Fax:251-206-6366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care