Provider Demographics
NPI:1922888148
Name:GULF COAST RECOVERY CLINIC
Entity Type:Organization
Organization Name:GULF COAST RECOVERY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-594-3377
Mailing Address - Street 1:14231 SEAWAY RD STE 2003
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4635
Mailing Address - Country:US
Mailing Address - Phone:228-594-3377
Mailing Address - Fax:
Practice Address - Street 1:14231 SEAWAY RD STE 2003
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4635
Practice Address - Country:US
Practice Address - Phone:228-594-3377
Practice Address - Fax:228-594-6688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder