Provider Demographics
NPI:1023090453
Name:GULF COAST HEALTH CARE, INC.
Entity type:Organization
Organization Name:GULF COAST HEALTH CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SANDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:NHA NURSING HOME ADM
Authorized Official - Phone:941-953-6949
Mailing Address - Street 1:1303 N TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-2432
Mailing Address - Country:US
Mailing Address - Phone:941-953-6949
Mailing Address - Fax:
Practice Address - Street 1:1303 N TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-2432
Practice Address - Country:US
Practice Address - Phone:941-953-6949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF16370968314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL228621Medicaid
FL106035Medicare ID - Type UnspecifiedPROVIDER NUMBER