Provider Demographics
NPI:1629349691
Name:EMERALD COAST CHILDREN'S ADVOCACY CENTER INC.
Entity Type:Organization
Organization Name:EMERALD COAST CHILDREN'S ADVOCACY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:HELEN
Authorized Official - Last Name:HURST
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:850-833-9237
Mailing Address - Street 1:P.O. BOX 1237
Mailing Address - Street 2:EMERALD COAST CHILDREN'S ADVOCACY CENTER INC.
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1237
Mailing Address - Country:US
Mailing Address - Phone:850-833-9237
Mailing Address - Fax:850-833-9238
Practice Address - Street 1:401 MCEWEN ST
Practice Address - Street 2:EMERALD COAST ADVOCACY CENTER, INC.
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2741
Practice Address - Country:US
Practice Address - Phone:850-833-9237
Practice Address - Fax:850-833-9238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251V00000X
251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========Medicaid