Healthcare Provider Details

I. General information

NPI: 1457709420
Provider Name (Legal Business Name): SPECIALIZED CG SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 CORPORATE SQ STE 133
NAPLES FL
34104-4704
US

IV. Provider business mailing address

4100 CORPORATE SQ STE 133
NAPLES FL
34104-4704
US

V. Phone/Fax

Practice location:
  • Phone: 239-307-5311
  • Fax: 239-307-5314
Mailing address:
  • Phone: 239-307-5311
  • Fax: 239-307-5314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberNR30211784
License Number StateFL

VIII. Authorized Official

Name: SLINA CARRERA
Title or Position: ADMINISTRATOR
Credential:
Phone: 239-307-5311