Provider Demographics
NPI:1144597774
Name:GULF COAST JEWISH FAMILY AND COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:GULF COAST JEWISH FAMILY AND COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINKO
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:727-479-1800
Mailing Address - Street 1:14041 ICOT BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-3702
Mailing Address - Country:US
Mailing Address - Phone:727-479-1800
Mailing Address - Fax:727-479-1800
Practice Address - Street 1:3950 BISCAYNE BLVD
Practice Address - Street 2:#300
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3721
Practice Address - Country:US
Practice Address - Phone:305-571-2116
Practice Address - Fax:305-571-2117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL97842OtherMEDICARE B