Healthcare Provider Details

I. General information

NPI: 1821431941
Provider Name (Legal Business Name): CAREHERE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 ALEXANDRIA BLVD
OVIEDO FL
32765-5547
US

IV. Provider business mailing address

310 ALEXANDRIA BLVD
OVIEDO FL
32765-5547
US

V. Phone/Fax

Practice location:
  • Phone: 407-971-4970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ERNIE CLEVENGER
Title or Position: PRESIDENT
Credential:
Phone: 615-221-5901