=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326413386
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOLD COAST ELDER & SOLUTIONS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2015
-----------------------------------------------------
Last Update Date | 12/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 W COMMERCIAL BLVD SUITE 202-C
-----------------------------------------------------
City | FT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33309-3073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-202-7822
-----------------------------------------------------
Fax | 954-202-7821
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 W COMMERCIAL BLVD SUITE 202-C
-----------------------------------------------------
City | FT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33309-3073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-202-7822
-----------------------------------------------------
Fax | 954-202-7821
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/PRESIDENT
-----------------------------------------------------
Name | GILBERT HIDALGO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-947-6464
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 30211354
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------