Provider Demographics
NPI:1508992454
Name:GULF COAST TEACHING FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:GULF COAST TEACHING FAMILY SERVICES, INC.
Other - Org Name:GULF COAST SOCIAL SERVICES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:504-831-6561
Mailing Address - Street 1:2400 EDENBORN AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-1817
Mailing Address - Country:US
Mailing Address - Phone:504-831-6561
Mailing Address - Fax:504-835-3156
Practice Address - Street 1:906 CM FEGAN DRIVE
Practice Address - Street 2:STE 3B/4B
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403
Practice Address - Country:US
Practice Address - Phone:985-542-1191
Practice Address - Fax:985-345-9910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARC6597251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1690091Medicaid