Provider Demographics
NPI:1578971818
Name:GULFSHORE PRIVATE HOME CARE, LLC
Entity Type:Organization
Organization Name:GULFSHORE PRIVATE HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:ERNST
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:239-249-5927
Mailing Address - Street 1:660 9TH ST N
Mailing Address - Street 2:SUITE 31-B
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-8141
Mailing Address - Country:US
Mailing Address - Phone:239-249-5927
Mailing Address - Fax:800-280-2442
Practice Address - Street 1:660 9TH ST N
Practice Address - Street 2:SUITE 31-B
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-8141
Practice Address - Country:US
Practice Address - Phone:239-249-5927
Practice Address - Fax:800-280-2442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211666251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health