Healthcare Provider Details

I. General information

NPI: 1700310422
Provider Name (Legal Business Name): DEDICATED SENIOR MEDICAL CENTER CLEARWATER, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 S HIGHLAND AVENUE DEDICATED SENIOR MEDICAL CENTER ST. CLEARWATER, LLC.
CLEARWATER FL
33756
US

IV. Provider business mailing address

1395 NW 167TH STREET CHEN MEDICAL CORPORATE OFFICE
MIAMI GARDENS FL
33169
US

V. Phone/Fax

Practice location:
  • Phone: 305-831-4761
  • Fax:
Mailing address:
  • Phone: 305-831-4761
  • Fax: 305-831-4761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: GLADYS FERNANDEZ-CORTES
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 305-498-4034