Provider Demographics
NPI:1508207820
Name:GULF COAST HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:GULF COAST HEALTH SERVICES LLC
Other - Org Name:RIGHT AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JUCEAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-929-1966
Mailing Address - Street 1:2344 BEE RIDGE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-6275
Mailing Address - Country:US
Mailing Address - Phone:941-929-1966
Mailing Address - Fax:941-929-1977
Practice Address - Street 1:2344 BEE RIDGE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-6275
Practice Address - Country:US
Practice Address - Phone:941-929-1966
Practice Address - Fax:941-929-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA299992371251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL688743100Medicaid