Provider Demographics
NPI:1073591343
Name:GULF COAST REHAB EQUIPMENT, INC.
Entity Type:Organization
Organization Name:GULF COAST REHAB EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-448-0464
Mailing Address - Street 1:805 BROOK STREET
Mailing Address - Street 2:SUITE 402
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-3431
Mailing Address - Country:US
Mailing Address - Phone:314-447-7500
Mailing Address - Fax:
Practice Address - Street 1:2821 COPTER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-7606
Practice Address - Country:US
Practice Address - Phone:850-494-0246
Practice Address - Fax:850-478-7111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1355332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031221500Medicaid