Provider Demographics
NPI:1861515801
Name:GULFSIDE HEALTHCARE INC
Entity type:Organization
Organization Name:GULFSIDE HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-470-6810
Mailing Address - Street 1:6361 PRESIDENTIAL CT STE 105
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3583
Mailing Address - Country:US
Mailing Address - Phone:239-470-6810
Mailing Address - Fax:239-938-9912
Practice Address - Street 1:6361 PRESIDENTIAL CT STE 105
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3583
Practice Address - Country:US
Practice Address - Phone:239-470-6810
Practice Address - Fax:239-938-9912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty