Healthcare Provider Details

I. General information

NPI: 1316360258
Provider Name (Legal Business Name): GULF COAST PALLIATIVE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12107 MAJESTIC BLVD
HUDSON FL
34667-2455
US

IV. Provider business mailing address

12107 MAJESTIC BLVD
HUDSON FL
34667-2455
US

V. Phone/Fax

Practice location:
  • Phone: 727-863-7971
  • Fax: 727-819-8571
Mailing address:
  • Phone: 727-863-7971
  • Fax: 727-819-8571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. WALTER RICHARD YOUNG
Title or Position: CHIEF FINNACIAL POSITION
Credential:
Phone: 727-863-7971