Provider Demographics
NPI:1497578918
Name:GULF COAST TOTALCARE
Entity type:Organization
Organization Name:GULF COAST TOTALCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-471-7392
Mailing Address - Street 1:251 COX ST, CWEB 1139
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604
Mailing Address - Country:US
Mailing Address - Phone:251-471-7392
Mailing Address - Fax:
Practice Address - Street 1:3280 DAUPHIN ST STE 115
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-4060
Practice Address - Country:US
Practice Address - Phone:251-471-7392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency