Provider Demographics
NPI:1992848634
Name:THE GULF COAST CENTER
Entity Type:Organization
Organization Name:THE GULF COAST CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIZONDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-763-2373
Mailing Address - Street 1:4444 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-1737
Mailing Address - Country:US
Mailing Address - Phone:409-763-2373
Mailing Address - Fax:409-978-2401
Practice Address - Street 1:7510 FM 1765
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-3672
Practice Address - Country:US
Practice Address - Phone:097-632-3734
Practice Address - Fax:409-978-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135222101Medicaid