Healthcare Provider Details

I. General information

NPI: 1356355358
Provider Name (Legal Business Name): GULF COAST HEALTH CARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 CENTER RD
VENICE FL
34285-5572
US

IV. Provider business mailing address

1646 S ORANGE AVE
SARASOTA FL
34239-2036
US

V. Phone/Fax

Practice location:
  • Phone: 941-408-8988
  • Fax: 941-408-8846
Mailing address:
  • Phone: 941-343-3033
  • Fax: 941-954-8725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberME97864
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW10105
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberME58216
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME58216
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY6161
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP9276826
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP9295470
License Number StateFL
# 8
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME97864
License Number StateFL

VIII. Authorized Official

Name: MR. DONALD CRAIG BRIMM
Title or Position: PRESIDENT
Credential: MBA
Phone: 941-343-3033