1467568287 NPI number — EMERALD COAST SUPPORT COORDINATORS, INC.

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 1467568287 NPI number — EMERALD COAST SUPPORT COORDINATORS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERALD COAST SUPPORT COORDINATORS, INC.
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:
1467568287
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
218 GREEN ACRES ROAD
Provider Second Line Business Mailing Address:
SUITE 800
Provider Business Mailing Address City Name:
FORT WALTON BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32547-7006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-862-7038
Provider Business Mailing Address Fax Number:
850-862-5089

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
218 GREEN ACRES ROAD
Provider Second Line Business Practice Location Address:
SUITE 800
Provider Business Practice Location Address City Name:
FORT WALTON BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32547-7006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-862-7038
Provider Business Practice Location Address Fax Number:
850-862-5089
Provider Enumeration Date:
08/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
BAKER
Authorized Official Title or Position:
PRESIDENT/ADMINISTRATOR
Authorized Official Telephone Number:
850-862-7038

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 673620368 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 673620396 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 673620398 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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