Organization
GULF COAST JEWISH FAMILY AND COMMUNITY SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORIS DIXON (CFO)
(727) 479-1800
Entity
Organization
Contact information
Practice address
14041 ICOT BLVD, CLEARWATER, FL 33760-3702
(727) 479-1800
(727) 479-1248
Mailing address
14041 ICOT BLVD, CLEARWATER, FL 33760-3702
(727) 479-1800
(727) 479-1248
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
029915401
MEDICAID - CM HILLSBOR
FL
05
—
060569700
MEDICAID - CMH PINELLAS
FL
05
—
060569701
MEDICAID - CM PINELLAS
FL
05
—
060569703
MEDICAID - BROWARD
FL
05
—
060569705
—
FL
05
—
060569710
MEDICAID - DARLINGTON
FL
05
—
060569715
—
FL
05
—
6356700
—
FL
Enumeration date
07/19/2007
Last updated
09/24/2018
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