Healthcare Provider Details

I. General information

NPI: 1922358795
Provider Name (Legal Business Name): GULF COAST EARLY STEPS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 17TH ST
SARASOTA FL
34235-1843
US

IV. Provider business mailing address

4630 17TH ST
SARASOTA FL
34235-1843
US

V. Phone/Fax

Practice location:
  • Phone: 941-487-5400
  • Fax: 941-487-5430
Mailing address:
  • Phone: 941-487-5400
  • Fax: 941-487-5430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: KWAME JAMES ALEXANDER
Title or Position: SERVICE COORDINATOR
Credential:
Phone: 941-487-5401