Provider Demographics
NPI:1235565730
Name:FIRST COAST COMMUNITY SUPPORT SERVICES
Entity Type:Organization
Organization Name:FIRST COAST COMMUNITY SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BIVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-738-8579
Mailing Address - Street 1:1010 E ADAMS ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-1902
Mailing Address - Country:US
Mailing Address - Phone:904-738-8579
Mailing Address - Fax:904-619-7835
Practice Address - Street 1:1010 E ADAMS ST
Practice Address - Street 2:SUITE 120
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-1902
Practice Address - Country:US
Practice Address - Phone:904-738-8579
Practice Address - Fax:904-619-7835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management