institution
Gulf Coast Mental Health Center
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Gulfport, Mississippi
NPI 1417934175

Gulf Coast Mental Health Center is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Gulfport, MS. Gulf Coast Mental Health Center practices in Gulfport, MS. The NPI Number for Gulf Coast Mental Health Center is 1417934175 and holds a License No. REG13-SO-01 (Mississippi).

The current practice location address for Gulf Coast Mental Health Center is 1600 Broad Ave, Gulfport, MS and can be reached out via phone at 228-863-1132 and via fax at 228-865-1700.

Location: 1600 Broad Ave, Gulfport, MS, 39501-3603
institution
Provider Profile Details
NPI Number
1417934175
Provider Name
Gulf Coast Mental Health Center
Credential
Provider Entity Type
Organization
Address
1600 Broad Ave, Gulfport, MS, 39501-3603
Phone Number
228-863-1132
Fax Number
228-865-1700
Provider Enumeration Date
12/23/2005
Last Update Date
03/12/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
C00120 01 MS CENTER MEDICARE ID
00018213 05 MS
QMP000005325798 01 MS MOLINA MEDICAID
institution
Provider Business Practice Location Address Details
Address
1600 Broad Ave
City
State
Zip
39501-3603
Phone Number
228-863-1132
Fax Number
228-865-1700
person
Provider Business Mailing Address Details
Address
1600 Broad Ave
City
State
Zip
39501-3603
Phone Number
228-863-1132
Fax Number
228-865-1700
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Psychologist
Speciality
Intellectual & Developmental Disabilities
Taxonomy
License No.
R-13-1 (Mississippi)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Mental Health (Including Community Mental Health Center)
Taxonomy
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 3
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
License No.
REG13-SO-01 (Mississippi)
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
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