NPIMap

Organization Active NPI

Gulf Coast Treatment Center

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Fort Walton Beach, FL
National Provider Identifier
1700985462
Registry record updated Mar 31, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
4454 Issued in FL
Legal business name
GULF COAST TREATMENT CENTER
Practice address
1015 Mar Walt Drive
Fort Walton Beach, FL 32547
Phone
(850) 863-4160
Fax
(850) 863-8576
NPI assigned
Sep 21, 2006
Last updated
Mar 31, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2009

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X 4454 FL
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 4454 FL Primary

Addresses

Primary practice location

1015 Mar Walt Drive
Fort Walton Beach, FL 32547

Mailing address

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

Other names 1

  • Gulf Coast Youth Services Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700985462. Details of each certification follow.

Hospital certification: CCN 104032

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
GULF COAST TREATMENT CENTER
Certification status
Terminated Voluntary: merger or closure, Apr 1, 2013
Provider type (POS)
Hospital – Psychiatric
Participating since
Dec 7, 1984
Last certification
Feb 11, 2016
Beds
24
Ownership / control type
Private (for profit)
Facility address
1015 Mar Walt Dr
Fort Walton Beach, FL 32547

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0984321Gulf Coast Treatment Center1015 Mar Walt Dr, Fort Walton Beach, FL 32547Certificate of waiverMar 19, 2027

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": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238457600000",
    "number": "1700985462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 MAR WALT DRIVE",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "32547",
            "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 DRIVE",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "32547",
            "telephone_number": "850-863-4160",
            "fax_number": "850-863-8576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF COAST TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2009-03-31",
        "status": "A",
        "authorized_official_last_name": "KAPLAN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "850-863-4160",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "FL",
            "license": "4454",
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "FL",
            "license": "4454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gulf Coast Youth Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fort Walton Beach, FL

Sources for this page

Verify at the official NPI Registry.