Healthcare Provider Details

I. General information

NPI: 1982897211
Provider Name (Legal Business Name): GCMK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 41LST ST
MARATHON FL
33050-0050
US

IV. Provider business mailing address

3000 41LST ST. OCEAN
MARATHON FL
33050
US

V. Phone/Fax

Practice location:
  • Phone: 305-434-9000
  • Fax: 305-434-9041
Mailing address:
  • Phone: 305-434-9000
  • Fax: 305-434-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. JAMIE PIFER
Title or Position: VICE-PRESIDENT
Credential:
Phone: 305-434-9000