Organization Active NPI

Gulf Breeze Home Health, Inc.

  • Home Health Agency
  • St Petersburg, FL
National Provider Identifier
1730646605
Registry record updated May 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
GULF BREEZE HOME HEALTH, INC.
Practice address
111 2ND Ave N Ste 319
St Petersburg, FL 33701-3315
Phone
(727) 623-0394
Fax
(727) 623-0398
NPI assigned
Feb 26, 2019
Last updated
May 6, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Lidia Montero
Title
VP
Phone
(786) 281-8400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NU Primary

Addresses

Primary practice location

111 2ND Ave N Ste 319
St Petersburg, FL 33701-3315

Mailing address

111 2ND Ave N Ste 319
St Petersburg, FL 33701-3315
Phone (727) 623-0394

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190924001127 FL Part A Provider - Home Health Agency 6406186147 Practice locations: Saint Petersburg, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730646605. Details of each certification follow.

Home health agency certification: CCN 687096

Legal name
GULF BREEZE HOME HEALTH, INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Mar 23, 2021
Last certification
Mar 23, 2021
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Dec 9, 2018 in FL
Enrollment address
111 2ND Ave NE
Ste 355
Saint Petersburg, FL 33701-3465

Care Compare: Home health agency

Medicare Care Compare
Listed as
Gulf Breeze Home Health IncCCN 687096 · All quality measures
Overall star rating
4.5 of 5
Ownership
Proprietary
Certified
Mar 23, 2021
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2165195Gulf Breeze Home Health, Inc111 2ND Ave, NE Ste 319, Saint Petersburg, FL 33701Certificate of waiverApr 22, 2027

National Provider Directory

National Provider Directory

Locations

111 2nd Ave NE
Ste 355
Saint Petersburg, FL 33701
Phone (727) 623-0394

111 2nd Ave N
Ste 319
St Petersburg, FL 33701
Phone (727) 623-0394

111 2nd Ave N
Ste 355
St Petersburg, FL 33701

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Marc Green Individual 5% Or Greater Direct Ownership Interest Dec 9, 2018 50%
Corporate OfficerCeo, President, Administrator Dec 9, 2018 50%
Corporate DirectorCeo, President, Administrator Dec 9, 2018 50%
W-2 Managing EmployeeCeo, President, Administrator Dec 9, 2018 50%
Operational/Managerial ControlCeo, President, Administrator Dec 9, 2018 50%
Lidia Montero Individual 5% Or Greater Direct Ownership Interest Dec 9, 2018 50%
Corporate OfficerVice President, Cfo Dec 9, 2018 50%
Corporate DirectorVice President, Cfo Dec 9, 2018 50%
W-2 Managing EmployeeVice President, Cfo Dec 9, 2018 50%
Operational/Managerial ControlVice President, Cfo Dec 9, 2018 50%

Practitioners & affiliated clinicians

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1551139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778025600000",
    "number": "1730646605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 2ND AVE N STE 319",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337013315",
            "telephone_number": "727-623-0394",
            "fax_number": "727-623-0398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 2ND AVE N STE 319",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337013315",
            "telephone_number": "727-623-0394",
            "fax_number": "727-623-0398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF BREEZE HOME HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-26",
        "last_updated": "2026-05-06",
        "certification_date": "2026-05-06",
        "status": "A",
        "authorized_official_last_name": "MONTERO",
        "authorized_official_first_name": "LIDIA",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "786-281-8400",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.