Provider Demographics
NPI:1851500409
Name:GULF COAST JEWISH FAMILY AND COMMUNITY SERVICES
Entity Type:Organization
Organization Name:GULF COAST JEWISH FAMILY AND COMMUNITY SERVICES
Other - Org Name:GULF COAST COMMUNITY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR CREDENTIALING/BILLING
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:JIMENEZ
Authorized Official - Last Name:YANDEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-430-3291
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 1:201 NE 40TH CT
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-1311
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:2007-05-21
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
FL8601320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060569703Medicaid
FL8601OtherSTATE OF FL - AHCA