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Organization
AGENCY FOR PERSONS WITH DISABILITIES
Active
Organization
AGENCY FOR PERSONS WITH DISABILITIES
Active
Other names
Gulf Coast Center ICF DD - State of Fl
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL S MAYFIELD (CENTER ADMINISTRATOR)
(239) 690-3652
Entity
Organization
Contact information
Practice address
5820 BUCKINGHAM ROAD, FT MYERS, FL 33905-7413
(239) 690-3662
(239) 694-5802
Mailing address
5820 BUCKINGHAM ROAD, FT MYERS, FL 33905-7413
(239) 694-2151
(239) 694-6231
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0280011-00
—
FL
05
—
0280089-00
—
FL
05
—
0280127-00
—
FL
05
—
0280135-00
—
FL
05
—
0280178-00
—
FL
05
—
0280224-00
—
FL
Enumeration date
12/04/2006
Last updated
06/18/2008
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