Provider Demographics
NPI:1770018731
Name:GULF COUNTY ASSOCIATION FOR RETARDED CITIZENS, INC.
Entity type:Organization
Organization Name:GULF COUNTY ASSOCIATION FOR RETARDED CITIZENS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRANSPORTATION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-229-6550
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:PORT ST JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32457-0008
Mailing Address - Country:US
Mailing Address - Phone:850-229-6550
Mailing Address - Fax:850-227-2084
Practice Address - Street 1:122 WATER PLANT ROAD
Practice Address - Street 2:
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456
Practice Address - Country:US
Practice Address - Phone:850-229-6550
Practice Address - Fax:850-227-2084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024386896Medicaid