Provider Demographics
NPI:1457580276
Name:GULF COAST TREATMENT CENTER, INC.
Entity type:Organization
Organization Name:GULF COAST TREATMENT CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-863-4160
Mailing Address - Street 1:4449 STRAIGHT LINE RD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-6720
Mailing Address - Country:US
Mailing Address - Phone:850-863-4160
Mailing Address - Fax:850-863-8576
Practice Address - Street 1:4449 STRAIGHT LINE RD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-6720
Practice Address - Country:US
Practice Address - Phone:850-863-4160
Practice Address - Fax:850-863-8576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility