Healthcare Provider Details

I. General information

NPI: 1477042620
Provider Name (Legal Business Name): CDS CARE & SUPPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2726 OAK RIDGE CT STE 502
FORT MYERS FL
33901-9356
US

IV. Provider business mailing address

2726 OAK RIDGE CT STE 502
FORT MYERS FL
33901-9356
US

V. Phone/Fax

Practice location:
  • Phone: 239-931-0158
  • Fax: 850-757-0070
Mailing address:
  • Phone: 239-931-0158
  • Fax: 850-757-0070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number299994703
License Number StateFL

VIII. Authorized Official

Name: MR. MANUEL CHAVEZ
Title or Position: CEO
Credential:
Phone: 239-931-0262