Provider Demographics
NPI:1063670800
Name:SUNCOAST CENTER FOR COMMUNITY MENTAL HEALTH
Entity Type:Organization
Organization Name:SUNCOAST CENTER FOR COMMUNITY MENTAL HEALTH
Other - Org Name:SUNCOAST CENTER SENIOR SUPPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-327-7656
Mailing Address - Street 1:3800 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-1237
Mailing Address - Country:US
Mailing Address - Phone:727-323-2528
Mailing Address - Fax:727-323-2521
Practice Address - Street 1:3800 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-1237
Practice Address - Country:US
Practice Address - Phone:727-323-2528
Practice Address - Fax:727-323-2521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL670728900Medicaid