Provider Demographics
NPI:1639487523
Name:GULF STATES MOBILITY AND REHAB LLC
Entity Type:Organization
Organization Name:GULF STATES MOBILITY AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAJORITY STOCKHOLDER
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GEROUX
Authorized Official - Suffix:
Authorized Official - Credentials:ATP
Authorized Official - Phone:662-418-1328
Mailing Address - Street 1:219 N BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:WAVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39576-4204
Mailing Address - Country:US
Mailing Address - Phone:662-418-1328
Mailing Address - Fax:229-467-8402
Practice Address - Street 1:511 ULMAN AVE
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-3524
Practice Address - Country:US
Practice Address - Phone:504-251-1492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment