Healthcare Provider Details

I. General information

NPI: 1346396397
Provider Name (Legal Business Name): GULF COAST TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12271 INTERCHANGE RD.
GRAND BAY AL
36541
US

IV. Provider business mailing address

PO BOX 1149
GRAND BAY AL
36541-1149
US

V. Phone/Fax

Practice location:
  • Phone: 251-865-0123
  • Fax: 251-865-0247
Mailing address:
  • Phone: 251-865-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberAL10034M
License Number StateAL

VIII. Authorized Official

Name: MS. LINDA GABRIEL
Title or Position: EXECUTIVE DIRECTOR
Credential: M.S., CMA
Phone: 251-865-0123