1972853067 NPI number — COMPASSIONATE CARE ADVOCATES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972853067 NPI number — COMPASSIONATE CARE ADVOCATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPASSIONATE CARE ADVOCATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972853067
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3277 TUMBLING RIVER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLERMONT
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34711-8909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-802-0315
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3277 TUMBLING RIVER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLERMONT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34711-8909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-802-0315
Provider Business Practice Location Address Fax Number:
866-571-5397
Provider Enumeration Date:
09/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SAID
Authorized Official First Name:
OMAR
Authorized Official Middle Name:
EZZAT
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
407-802-0315

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 007836000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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