Provider Demographics
NPI:1700832466
Name:GULF COAST HEALTH CARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:GULF COAST HEALTH CARE ASSOCIATES LLC
Other - Org Name:SEA BREEZE HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-769-7686
Mailing Address - Street 1:1937 JENKS AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4510
Mailing Address - Country:US
Mailing Address - Phone:850-769-7686
Mailing Address - Fax:850-769-7680
Practice Address - Street 1:1937 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4510
Practice Address - Country:US
Practice Address - Phone:850-769-7686
Practice Address - Fax:850-769-7680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF11870961314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025224700Medicaid
105391Medicare Oscar/Certification