Provider Demographics
NPI:1811168776
Name:GOLD COAST COMPASSIONATE CARE,INC
Entity type:Organization
Organization Name:GOLD COAST COMPASSIONATE CARE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:BOYLAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:954-462-1233
Mailing Address - Street 1:901 PROGRESSO DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-1943
Mailing Address - Country:US
Mailing Address - Phone:954-462-1233
Mailing Address - Fax:954-462-2981
Practice Address - Street 1:901 PROGRESSO DR
Practice Address - Street 2:SUITE 204
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-1943
Practice Address - Country:US
Practice Address - Phone:954-462-1233
Practice Address - Fax:954-462-2981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211267251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health