Provider Demographics
NPI:1619173663
Name:GULFSIDE HEALTH & REHAB CENTER LLC
Entity Type:Organization
Organization Name:GULFSIDE HEALTH & REHAB CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAMANTIDES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-457-0636
Mailing Address - Street 1:9438 US HIGHWAY 19N
Mailing Address - Street 2:#182
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668
Mailing Address - Country:US
Mailing Address - Phone:727-848-5790
Mailing Address - Fax:727-848-4260
Practice Address - Street 1:9438 US HIGHWAY 19N
Practice Address - Street 2:#182
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668
Practice Address - Country:US
Practice Address - Phone:727-848-5790
Practice Address - Fax:727-848-4260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8790111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty