MEDICARE: GULF COAST VILLAGE HOME HEALTH

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	251E00000X	Home Health Agency	HHA29991969	FL

General Provider Information

NPI Number	:	1215938535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULF COAST VILLAGE HOME HEALTH

Provider Business Mailing Address
First Line	:	1435 SANTA BARBARA BLVD STE 1
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-2842
Country	:	US
Telephone Number	:	239-772-7480
Fax Number	:

Provider Business Practice Location Address
First Line	:	1435 SANTA BARBARA BLVD STE 1
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-2842
Country	:	US
Telephone Number	:	239-772-7480
Fax Number	:	239-772-7980

Authorized Official
Title or Position	:	DIR. OF HOME & COMM BASED SERVICES
Name	:	SARAH RUTH SMITH
Credential	:	RN
Telephone Number	:	239-772-7480

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	03/27/2024

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