Gulf Coast Recovery Clinic

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

GULF COAST RECOVERY CLINIC

Practice address

14231 Seaway Rd Ste 2003
Gulfport, MS 39503-4635

Phone

(228) 594-3377

Fax

(228) 594-6688

NPI assigned

Oct 4, 2023

Last updated

Oct 4, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Betty Matthews

Title

Manager

Phone

(228) 594-3377

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Avery Jackson, APRN, FNP-C

  • Family Nurse Practitioner
  • Gulfport, MS
  • NPI 1548798218
  Medicare reassignment NPD

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

{
    "created_epoch": "1696377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1922888148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14231 SEAWAY RD STE 2003",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395034635",
            "telephone_number": "228-594-3377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14231 SEAWAY RD STE 2003",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395034635",
            "telephone_number": "228-594-3377",
            "fax_number": "228-594-6688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF COAST RECOVERY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-04",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "MATTHEWS",
        "authorized_official_first_name": "BETTY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "228-594-3377"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gulf Coast Periodontics & Implants LLC
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• Gulf Coast Psychotherapy
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• Gulf Coast Value Cab
• Gulf South Heart & Vascular Institute, PLLC
• Gulf South Pediatric Cardiology, LLC

• Substance Use Disorder Rehabilitation Clinic/Center in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.