Provider Demographics
NPI:1841418332
Name:GULF COAST YOUTH SERVICES
Entity Type:Organization
Organization Name:GULF COAST YOUTH SERVICES
Other - Org Name:OKALOOSA YOUTH ACADEMY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-863-4160
Mailing Address - Street 1:4455 STRAIGHT LINE RD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-6720
Mailing Address - Country:US
Mailing Address - Phone:850-863-4160
Mailing Address - Fax:
Practice Address - Street 1:4455 STRAIGHT LINE RD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-6720
Practice Address - Country:US
Practice Address - Phone:850-863-4160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL260390701652311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility