Healthcare Provider Details

I. General information

NPI: 1851500409
Provider Name (Legal Business Name): GULF COAST JEWISH FAMILY AND COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NE 40TH CT
OAKLAND PARK FL
33334-1311
US

IV. Provider business mailing address

14041 ICOT BLVD
CLEARWATER FL
33760-3702
US

V. Phone/Fax

Practice location:
  • Phone: 727-450-7269
  • Fax: 727-479-1248
Mailing address:
  • Phone: 727-450-7269
  • Fax: 727-479-1248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number8601
License Number StateFL

VIII. Authorized Official

Name: CAROLYN JIMENEZ YANDEK
Title or Position: DIRECTOR CREDENTIALING/BILLING
Credential:
Phone: 727-430-3291