{
"Npi": {
"NPI": "1710128418",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GOLD COAST HOME HEALTH, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5291 PROVIDENCE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MATTESON",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60443-1188",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "312-315-1934",
"MailingAddressFaxNumber": "312-229-0067",
"FirstLinePracticeLocationAddress": "20200 GOVERNORS DR STE 204",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OLYMPIA FIELDS",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60461-1056",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "773-488-3800",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/10/2009",
"LastUpdateDate": "12/06/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HADZIDE",
"AuthorizedOfficialFirstName": "REUBEN",
"AuthorizedOfficialMiddleName": "CUDJOE",
"AuthorizedOfficialTitle": "ADMINISTRATOR/PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MR.",
"AuthorizedOfficialTelephoneNumber": "312-315-1934",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}