Provider Demographics
NPI:1568662476
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: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:727-479-1800
Mailing Address - Fax:727-479-1248
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:727-479-1800
Practice Address - Fax:727-479-1248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6356700Medicaid
FL060569705Medicaid
FL060569703MedicaidMEDICAID - BROWARD
FL029915401MedicaidMEDICAID - CM HILLSBOR
FL060569701MedicaidMEDICAID - CM PINELLAS
FL060569715Medicaid
FL060569700MedicaidMEDICAID - CMH PINELLAS
FL060569710MedicaidMEDICAID - DARLINGTON
FL060569715Medicaid