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General NPI Number Information
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NPI Number | 1780814152
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Entity Type | Organization
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Legal Business Name | GULF COAST HEALTHCARE GROUP
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Dates
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Enumeration Date | 07/20/2009
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Last Update Date | 07/20/2009
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Provider Practice Location Address
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Address Line | 12989 JUPITER RD SUITE 104
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City | DALLAS
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State | TX
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Zip | 75238-3212
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Country | US
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Telephone | 469-254-0980
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Fax | 972-429-9233
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Provider Business Mailing Address
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Address Line | 301 W KIRBY ST SUITE 233
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City | WYLIE
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State | TX
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Zip | 75098-4194
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Country | US
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Telephone | 469-254-0980
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Fax | 972-429-9233
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Authorized Official
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Title or Position | PRESIDENT
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Name | KWESI A DARQUAH
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Credential |
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Telephone | 469-245-0980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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