Provider Demographics
NPI:1891058616
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:J
Authorized Official - Last Name:WASHINKO
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
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 1:5623 US HIGHWAY 19
Practice Address - Street 2:SUITE 304
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-3700
Practice Address - Country:US
Practice Address - Phone:727-937-2813
Practice Address - Fax:727-749-1248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0605697-Medicaid