Provider Demographics
NPI:1962432849
Name:INTERIM HEALTHCARE GULF COAST, INC.
Entity type:Organization
Organization Name:INTERIM HEALTHCARE GULF COAST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPELLISSY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-441-9585
Mailing Address - Street 1:1940 DREW ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3000
Mailing Address - Country:US
Mailing Address - Phone:727-441-9585
Mailing Address - Fax:727-461-4535
Practice Address - Street 1:2511 W COLUMBUS DR
Practice Address - Street 2:SUITE A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-2211
Practice Address - Country:US
Practice Address - Phone:813-877-9444
Practice Address - Fax:813-872-8150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20584096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650969000Medicaid
FL650969000Medicaid