Provider Demographics
NPI:1649032889
Name:PCAH GUSHUE LLC
Entity type:Organization
Organization Name:PCAH GUSHUE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSHUE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:321-329-5300
Mailing Address - Street 1:1275 S PATRICK DR # A3
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3963
Mailing Address - Country:US
Mailing Address - Phone:321-329-5300
Mailing Address - Fax:321-329-5300
Practice Address - Street 1:1275 S PATRICK DR # A3
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3963
Practice Address - Country:US
Practice Address - Phone:321-329-5300
Practice Address - Fax:321-329-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care