Basic Information
| Provider Information | |||||||||
| NPI: | 1578795332 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMERALD COAST BEHAVIORAL HOSPITAL, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1940 HARRISON AVENUE | ||||||||
| Address2: | |||||||||
| City: | PANAMA CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324054542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8507630017 | ||||||||
| FaxNumber: | 8505326462 | ||||||||
| Practice Location | |||||||||
| Address1: | 1940 HARRISON AVENUE | ||||||||
| Address2: | |||||||||
| City: | PANAMA CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324054542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8507630017 | ||||||||
| FaxNumber: | 8505326462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2009 | ||||||||
| LastUpdateDate: | 01/24/2013 | ||||||||
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| AuthorizedOfficialLastName: | FILTON | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR VP & CFO | ||||||||
| AuthorizedOfficialTelephone: | 6107683300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | N | Hospitals | Psychiatric Hospital | 2084P0800X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 283Q00000X | 4500 | FL | Y | Hospitals | Psychiatric Hospital |
ID Information
| ID | Type | State | Issuer | Description | 001652300 | 05 | FL | MEDICAID |