Provider Demographics
NPI:1770672032
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:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINKO
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
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: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:727-450-7269
Practice Address - Fax:727-479-1248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251S00000X
FL323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006356700OtherMANAGED CARE PROVIDER ID
FL060569700Medicaid
FL060569710Medicaid
FL060569715Medicaid
FL234010OtherAMERIGROUP
FL7812787OtherAETNA
FL060569701Medicaid
FL060569709Medicaid
1130180OtherPSYCHCARE
FL224612000OtherMAGELLAN
FL029915401Medicaid
FL177849OtherMHN NETWORK
FLZ105YOtherBCBS OF FLORIDA
FL060569703Medicaid
FL060569714Medicaid
FL029915400Medicaid
FL060569709Medicaid
FL060569709Medicaid