Healthcare Provider Details

I. General information

NPI: 1528478039
Provider Name (Legal Business Name): GULF COAST OPPORTUNITY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 GALVESTON ROAD
HOUSTON TX
77017
US

IV. Provider business mailing address

4333 SHREVEPORT HWY
PINEVILLE LA
71360
US

V. Phone/Fax

Practice location:
  • Phone: 713-475-2228
  • Fax: 318-641-6282
Mailing address:
  • Phone: 318-445-6470
  • Fax: 318-641-6282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: TED SMITH
Title or Position: DIRECTOR
Credential:
Phone: 318-641-3717