Provider Demographics
NPI:1174900609
Name:PROHEALTH-GULF COAST, LLC
Entity type:Organization
Organization Name:PROHEALTH-GULF COAST, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:205-820-7000
Mailing Address - Street 1:717 37TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35222-3244
Mailing Address - Country:US
Mailing Address - Phone:205-820-7000
Mailing Address - Fax:844-358-0261
Practice Address - Street 1:105B LOTTIE LN
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2995
Practice Address - Country:US
Practice Address - Phone:251-517-7556
Practice Address - Fax:251-517-7669
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROHEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-05
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2671-HH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health