First Coast Community Support Services

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

FIRST COAST COMMUNITY SUPPORT SERVICES

Practice address

5300 San Juan Ave
Jacksonville, FL 32210-3142

Phone

(904) 738-8579

Fax

(904) 619-7835

NPI assigned

Jul 13, 2021

Organization subpart

Yes

Parent organization

FIRST COAST COMMUNITY SUPPORT SERVICESAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Denise Boyd, MSNPI 1033243159

Title

Administrator

Phone

(904) 738-8579

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Tax ID family

First Coast Community Support Services2 organizations share this tax ID, including this one

Part of

First Coast Community Support Services

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• First Coast Community Support Services

  • Case Management Agency
  • Jacksonville, FL
  • NPI 1235565730
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• First Coast Community Support Services

  • Case Management Agency
  • Jacksonville, FL
  • NPI 1235565730
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Denise Boyd, BS

  • Social Worker
  • Jacksonville, FL
  • NPI 1033243159
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626134400000",
    "number": "1184296832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 SAN JUAN AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322103142",
            "telephone_number": "904-738-8579",
            "fax_number": "904-619-7835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 SAN JUAN AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322103142",
            "telephone_number": "904-738-8579",
            "fax_number": "904-619-7835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST COAST COMMUNITY SUPPORT SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FIRST COAST COMMUNITY SUPPORT SERVICES",
        "enumeration_date": "2021-07-13",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-13",
        "status": "A",
        "authorized_official_last_name": "BOYD",
        "authorized_official_first_name": "DENISE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "904-738-8579",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103272401",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "DBOYD@FCCSUPPORTSERVICE.COM",
            "affiliation": "N",
            "address_1": "5300 San Juan Ave",
            "city": "Jacksonville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "322103142",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• First Coast Community Support Services
• First Coast Community Wellness Services LLC
• First Coast Counseling and Life Coaching, Inc.
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• First Coast Dental Center, PLLC

• Community/Behavioral Health Agency in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Community/Behavioral Health Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.