Provider Demographics
NPI:1487052650
Name:GULF COAST SENIOR CARE INC
Entity type:Organization
Organization Name:GULF COAST SENIOR CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-488-3410
Mailing Address - Street 1:209 NASSAU ST S
Mailing Address - Street 2:STE 101
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2358
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 NASSAU ST S
Practice Address - Street 2:STE 101
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2358
Practice Address - Country:US
Practice Address - Phone:941-488-3410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care