Provider Demographics
NPI:1750531489
Name:GULFSIDE PALLIATIVE CARE, LLC
Entity type:Organization
Organization Name:GULFSIDE PALLIATIVE CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:727-845-5707
Mailing Address - Street 1:2061 COLLIER PKWY
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-5202
Mailing Address - Country:US
Mailing Address - Phone:727-845-5707
Mailing Address - Fax:727-484-7994
Practice Address - Street 1:5760 DEAN DAIRY RD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-0751
Practice Address - Country:US
Practice Address - Phone:813-501-8201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GULFSIDE HOSPICE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-30
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14752300Medicaid