Provider Demographics
NPI:1467568287
Name:EMERALD COAST SUPPORT COORDINATORS, INC.
Entity Type:Organization
Organization Name:EMERALD COAST SUPPORT COORDINATORS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:BAKER
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-862-7038
Mailing Address - Street 1:218 GREEN ACRES ROAD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-7006
Mailing Address - Country:US
Mailing Address - Phone:850-862-7038
Mailing Address - Fax:850-862-5089
Practice Address - Street 1:218 GREEN ACRES ROAD
Practice Address - Street 2:SUITE 800
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-7006
Practice Address - Country:US
Practice Address - Phone:850-862-7038
Practice Address - Fax:850-862-5089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X
251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL673620368Medicaid
FL673620396Medicaid
FL673620398Medicaid