=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982642286
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GULF HOMECARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2006
-----------------------------------------------------
Last Update Date | 12/01/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 COLLEGE AVE
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36545-2533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-262-6477
-----------------------------------------------------
Fax | 251-247-1080
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 51266
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70505-1266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-233-1307
-----------------------------------------------------
Fax | 337-233-5764
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TREASURER
-----------------------------------------------------
Name | MR. JOSHUA L PROFFITT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 337-233-1307
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | N/A
-----------------------------------------------------
License Number State |
-----------------------------------------------------