Provider Demographics
NPI:1528694254
Name:GULFSTREAM HEALTH LLC
Entity type:Organization
Organization Name:GULFSTREAM HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:D'AMICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-695-6273
Mailing Address - Street 1:3716 STANDRIDGE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-4566
Mailing Address - Country:US
Mailing Address - Phone:214-695-6273
Mailing Address - Fax:
Practice Address - Street 1:3716 STANDRIDGE DR STE 201
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-4566
Practice Address - Country:US
Practice Address - Phone:214-695-6273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical