Healthcare Provider Details

I. General information

NPI: 1033578448
Provider Name (Legal Business Name): CAREHERE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4065 N LECANTO HWY STE 600-900
BEVERLY HILLS FL
34465-3555
US

IV. Provider business mailing address

5141 VIRGINIA WAY STE 350
BRENTWOOD TN
37027-2319
US

V. Phone/Fax

Practice location:
  • Phone: 615-221-5901
  • Fax:
Mailing address:
  • Phone: 615-221-5901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME113657
License Number StateFL

VIII. Authorized Official

Name: MR. ERNEST CLEVENGER
Title or Position: PRESIDENT
Credential:
Phone: 615-221-5901