Healthcare Provider Details

I. General information

NPI: 1578795332
Provider Name (Legal Business Name): EMERALD COAST BEHAVIORAL HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2009
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 HARRISON AVENUE
PANAMA CITY FL
32405-4542
US

IV. Provider business mailing address

1940 HARRISON AVENUE
PANAMA CITY FL
32405-4542
US

V. Phone/Fax

Practice location:
  • Phone: 850-763-0017
  • Fax: 850-532-6462
Mailing address:
  • Phone: 850-763-0017
  • Fax: 850-532-6462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number4500
License Number StateFL

VIII. Authorized Official

Name: STEVE FILTON
Title or Position: SR VP & CFO
Credential:
Phone: 610-768-3300