Provider Demographics
NPI:1487863890
Name:GULF COAST JEWISH FAMLY AND COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:GULF COAST JEWISH FAMLY AND COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
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:727-450-7269
Mailing Address - Fax:
Practice Address - Street 1:14041 ICOT BLVD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3702
Practice Address - Country:US
Practice Address - Phone:727-450-7269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL080840701Medicaid