Provider Demographics
NPI:1477960912
Name:PROHEALTH-GULF COAST, LLC
Entity Type:Organization
Organization Name:PROHEALTH-GULF COAST, LLC
Other - Org Name:PROHEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:205-820-7000
Mailing Address - Street 1:717 37TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35222-3244
Mailing Address - Country:US
Mailing Address - Phone:866-330-0609
Mailing Address - Fax:855-301-9880
Practice Address - Street 1:105B LOTTIE LN
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2995
Practice Address - Country:US
Practice Address - Phone:866-330-0609
Practice Address - Fax:855-301-9880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2671-HH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL01-7180Medicare PIN