Healthcare Provider Details

I. General information

NPI: 1801897541
Provider Name (Legal Business Name): CG MADISON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2481 W US 90
MADISON FL
32340-4306
US

IV. Provider business mailing address

2123 CENTRE POINTE BLVD
TALLAHASSEE FL
32308-4930
US

V. Phone/Fax

Practice location:
  • Phone: 850-973-4880
  • Fax: 850-973-2667
Mailing address:
  • Phone: 850-386-2831
  • Fax: 850-386-1552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. JOSEPH D. MITCHELL
Title or Position: PRESIDENT
Credential:
Phone: 850-386-2522