Provider Demographics
NPI:1144328881
Name:GULFSIDE HOSPICE, INC.
Entity type:Organization
Organization Name:GULFSIDE HOSPICE, INC.
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:813-428-5926
Practice Address - Street 1:2061 COLLIER PKWY
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-5202
Practice Address - Country:US
Practice Address - Phone:727-845-5707
Practice Address - Fax:813-428-5926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5005096251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL087570800Medicaid
FL087570800Medicaid