Healthcare Provider Details

I. General information

NPI: 1104225960
Provider Name (Legal Business Name): GOLD COAST HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3470 E COAST AVE 1503
MIAMI FL
33137-3986
US

IV. Provider business mailing address

3470 E COAST AVE 1503
MIAMI FL
33137-3986
US

V. Phone/Fax

Practice location:
  • Phone: 305-458-2840
  • Fax:
Mailing address:
  • Phone: 305-458-2840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRIS WILLIAMS
Title or Position: CEO
Credential:
Phone: 305-458-2840