Organization
GULF COAST MENTAL HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MANDY MCDONALD (BILLING SUPERVISOR)
(228) 863-1132
Entity
Organization
Contact information
Practice address
1600 BROAD AVENUE, GULFPORT, MS 39501-3603
(228) 869-1132
(228) 865-1700
Mailing address
1600 BROAD AVENUE, GULFPORT, MS 39501-3603
(228) 869-1132
(228) 865-1700
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
M9175
MS
Other
Enumeration date
03/20/2018
Last updated
03/20/2018
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