Healthcare Provider Details

I. General information

NPI: 1508207820
Provider Name (Legal Business Name): GULF COAST HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2344 BEE RIDGE RD SUITE 102
SARASOTA FL
34239-6275
US

IV. Provider business mailing address

2344 BEE RIDGE RD SUITE 102
SARASOTA FL
34239-6275
US

V. Phone/Fax

Practice location:
  • Phone: 941-929-1966
  • Fax: 941-929-1977
Mailing address:
  • Phone: 941-929-1966
  • Fax: 941-929-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA299992371
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHHA299992371
License Number StateFL

VIII. Authorized Official

Name: MICHAEL JUCEAM
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 941-929-1966