Provider Demographics
NPI:1356355358
Name:GULF COAST HEALTH CARE SERVICES, INC.
Entity type:Organization
Organization Name:GULF COAST HEALTH CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:BRIMM
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:941-343-3033
Mailing Address - Street 1:1646 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2036
Mailing Address - Country:US
Mailing Address - Phone:941-343-3033
Mailing Address - Fax:941-954-8725
Practice Address - Street 1:153 CENTER RD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-5572
Practice Address - Country:US
Practice Address - Phone:941-408-8988
Practice Address - Fax:941-408-8846
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL HOSPITAL RECRUITING SERVICE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-28
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME978642084P0802X, 2084P0800X
FLSW101051041C0700X
FLME582162084P0805X, 2084P0800X
FLPY6161103T00000X
FLARNP9276826363LP0808X
FLARNP9295470363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002809900Medicaid
FL002809901Medicaid
FL002809900Medicaid