Provider Demographics
NPI:1528496577
Name:GULF BREEZE TREATMENT CENTER
Entity type:Organization
Organization Name:GULF BREEZE TREATMENT CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JUILE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-934-0790
Mailing Address - Street 1:350 PENSACOLA BEACH RD
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-4882
Mailing Address - Country:US
Mailing Address - Phone:850-934-0790
Mailing Address - Fax:850-934-0796
Practice Address - Street 1:350 PENSACOLA BEACH RD
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4882
Practice Address - Country:US
Practice Address - Phone:850-934-0790
Practice Address - Fax:850-934-0796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility