Provider Demographics
NPI:1699456632
Name:GULF COAST CARE, LLC
Entity type:Organization
Organization Name:GULF COAST CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:228-493-5566
Mailing Address - Street 1:303 REESE ST
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-2823
Mailing Address - Country:US
Mailing Address - Phone:228-493-5566
Mailing Address - Fax:
Practice Address - Street 1:303 REESE ST
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-2823
Practice Address - Country:US
Practice Address - Phone:228-493-5566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care