Healthcare Provider Details

I. General information

NPI: 1972191641
Provider Name (Legal Business Name): WESTCARE GULFCOAST FLORIDA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 CENTRAL AVE
ST PETERSBURG FL
33712-1151
US

IV. Provider business mailing address

PO BOX 94738
LAS VEGAS NV
89193-4738
US

V. Phone/Fax

Practice location:
  • Phone: 727-490-6768
  • Fax: 727-541-3993
Mailing address:
  • Phone: 702-385-2090
  • Fax: 702-924-2575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: FRANK RABBITO
Title or Position: COO
Credential:
Phone: 305-573-3784