MEDICARE: EMERALD COAST SUPPORT COORDINATORS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency		FL
2	251C00000X	Developmentally Disabled Services Day Training Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467568287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERALD COAST SUPPORT COORDINATORS, INC.

Provider Business Mailing Address
First Line	:	218 GREEN ACRES ROAD
Second Line	:	SUITE 800
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-7006
Country	:	US
Telephone Number	:	850-862-7038
Fax Number	:	850-862-5089

Provider Business Practice Location Address
First Line	:	218 GREEN ACRES ROAD
Second Line	:	SUITE 800
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-7006
Country	:	US
Telephone Number	:	850-862-7038
Fax Number	:	850-862-5089

Authorized Official
Title or Position	:	PRESIDENT/ADMINISTRATOR
Name	:	MRS. BARBARA BAKER THOMAS
Credential	:
Telephone Number	:	850-862-7038

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	04/19/2023

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