Healthcare Provider Details

I. General information

NPI: 1467568287
Provider Name (Legal Business Name): EMERALD COAST SUPPORT COORDINATORS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 GREEN ACRES ROAD SUITE 800
FORT WALTON BEACH FL
32547-7006
US

IV. Provider business mailing address

218 GREEN ACRES ROAD SUITE 800
FORT WALTON BEACH FL
32547-7006
US

V. Phone/Fax

Practice location:
  • Phone: 850-862-7038
  • Fax: 850-862-5089
Mailing address:
  • Phone: 850-862-7038
  • Fax: 850-862-5089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. BARBARA BAKER THOMAS
Title or Position: PRESIDENT/ADMINISTRATOR
Credential:
Phone: 850-862-7038