Provider Demographics
NPI:1477676237
Name:ST JOSEPH CARE OF FLORIDA, INC.
Entity Type:Organization
Organization Name:ST JOSEPH CARE OF FLORIDA, INC.
Other - Org Name:GULF COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:KENT
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:850-227-1276
Mailing Address - Street 1:2475 GARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32456-5265
Mailing Address - Country:US
Mailing Address - Phone:850-227-1276
Mailing Address - Fax:850-227-1794
Practice Address - Street 1:2475 GARRISON AVE
Practice Address - Street 2:
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-5265
Practice Address - Country:US
Practice Address - Phone:850-227-1276
Practice Address - Fax:850-227-1794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2014-05-06
Deactivation Date:2008-08-07
Deactivation Code:
Reactivation Date:2014-05-06
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686728604Medicaid
FL686728600Medicaid
FL686728601Medicaid
FL686728605Medicaid
FL686728602Medicaid
FL101944Medicare Oscar/Certification
FL686728605Medicaid
FL101948Medicare Oscar/Certification