1407065816 NPI number — GULF COAST JEWISH FAMILY SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407065816 NPI number — GULF COAST JEWISH FAMILY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GULF COAST JEWISH FAMILY 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:
GULF COAST COMMUNITY CARE
Provider Other Organization Name Type Code:
3
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:
1407065816
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2011
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:
14041 ICOT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARWATER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33760-3702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-450-7269
Provider Business Practice Location Address Fax Number:
727-479-1248
Provider Enumeration Date:
05/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WASHINKO
Authorized Official First Name:
CARLA
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
727-479-1800

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 060569701 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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