Provider Demographics
NPI:1093597759
Name:GULF COAST AL SENIOR CARE, LLC
Entity Type:Organization
Organization Name:GULF COAST AL SENIOR CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-305-4500
Mailing Address - Street 1:1928 HOGAN DR
Mailing Address - Street 2:
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36542-7400
Mailing Address - Country:US
Mailing Address - Phone:251-305-4500
Mailing Address - Fax:251-901-2929
Practice Address - Street 1:1203 US HIGHWAY 98 BLDG 1 UNIT D & E
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4277
Practice Address - Country:US
Practice Address - Phone:251-305-4500
Practice Address - Fax:251-901-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care