1245440874 NPI number — GULF COAST JEWISH FAMILY AND COMMUNITY SERVICES

Table of content: (NPI 1245440874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245440874 NPI number — GULF COAST JEWISH FAMILY AND COMMUNITY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GULF COAST JEWISH FAMILY AND COMMUNITY SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245440874
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14041 ICOT BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33760-3702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-450-7269
Provider Business Mailing Address Fax Number:
727-479-1248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3142 DARLINGTON ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLIDAY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-430-3291
Provider Business Practice Location Address Fax Number:
727-479-1248
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YANDEK
Authorized Official First Name:
CAROLYN
Authorized Official Middle Name:
JIMENEZ
Authorized Official Title or Position:
DIRECTOR CREDENTIALING/BILLING
Authorized Official Telephone Number:
727-430-3291

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 323P00000X , with the licence number: 8618 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 060569710 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com