Provider Demographics
NPI:1346396397
Name:GULF COAST TREATMENT CENTER
Entity Type:Organization
Organization Name:GULF COAST TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CMA
Authorized Official - Phone:251-865-0123
Mailing Address - Street 1:PO BOX 1149
Mailing Address - Street 2:
Mailing Address - City:GRAND BAY
Mailing Address - State:AL
Mailing Address - Zip Code:36541-1149
Mailing Address - Country:US
Mailing Address - Phone:251-865-0123
Mailing Address - Fax:
Practice Address - Street 1:12271 INTERCHANGE RD.
Practice Address - Street 2:
Practice Address - City:GRAND BAY
Practice Address - State:AL
Practice Address - Zip Code:36541
Practice Address - Country:US
Practice Address - Phone:251-865-0123
Practice Address - Fax:251-865-0247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL10034M261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL111108OtherREGISTERED PHARMACY
ALAL10034MOtherFEDERAL OTP NUMBER