Provider Demographics
NPI:1609101153
Name:GULFSIDE HEALTH & REHAB
Entity Type:Organization
Organization Name:GULFSIDE HEALTH & REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAMANTIDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-890-7246
Mailing Address - Street 1:8316 HANLEY RD
Mailing Address - Street 2:STE 1-2
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-2284
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8316 HANLEY RD
Practice Address - Street 2:STE 1-2
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-2284
Practice Address - Country:US
Practice Address - Phone:813-890-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 8790261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center