NPIMap

Organization Active NPI

Gulf Coast Youth Services

Doing business as Gulf Coast Youth Academy

  • Custodial Care Facility
  • Fort Walton Beach, FL
National Provider Identifier
1407073620
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Custodial Care FacilityTaxonomy code 311Z00000X
License
260390701652 Issued in FL
Legal business name
GULF COAST YOUTH SERVICES
Doing business as
Gulf Coast Youth Academy
Practice address
1015 Mar Walt Dr
Fort Walton Beach, FL 32547-6738
Phone
(850) 863-4160
Fax
(850) 863-8576
NPI assigned
Apr 19, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Jeffrey Kaplan
Title
Ceo
Phone
(850) 863-4160

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Custodial Care Facility 311Z00000X 260390701652 FL Primary

Addresses

Primary practice location

1015 Mar Walt Dr
Fort Walton Beach, FL 32547-6738

Mailing address

1015 Mar Walt Dr
Fort Walton Beach, FL 32547-6738
Phone (850) 863-4160

Other names 1

  • Gulf Coast Youth Academy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Gulf Coast Youth Services6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407073620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 MAR WALT DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476738",
            "telephone_number": "850-863-4160",
            "fax_number": "850-863-8576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 MAR WALT DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476738",
            "telephone_number": "850-863-4160",
            "fax_number": "850-863-8576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF COAST YOUTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KAPLAN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "850-863-4160",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": "FL",
            "license": "260390701652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gulf Coast Youth Academy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Walton Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.