MEDICARE: GULFSIDE HOSPICE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	5005096	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144328881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULFSIDE HOSPICE, INC.

Provider Business Mailing Address
First Line	:	2061 COLLIER PKWY
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-5202
Country	:	US
Telephone Number	:	727-845-5707
Fax Number	:	813-428-5926

Provider Business Practice Location Address
First Line	:	2061 COLLIER PKWY
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-5202
Country	:	US
Telephone Number	:	727-845-5707
Fax Number	:	813-428-5926

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	MS. LINDA LOUISE WARD
Credential	:	MSW
Telephone Number	:	727-845-5707

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	04/02/2019

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