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General NPI Number Information
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NPI Number | 1457709420
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Entity Type | Organization
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Legal Business Name | SPECIALIZED CG SERVICES, LLC
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Dates
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Enumeration Date | 05/31/2016
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 4100 CORPORATE SQ STE 133
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City | NAPLES
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State | FL
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Zip | 34104-4704
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Country | US
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Telephone | 239-307-5311
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Fax | 239-307-5314
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Provider Business Mailing Address
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Address Line | 4100 CORPORATE SQ STE 133
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City | NAPLES
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State | FL
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Zip | 34104-4704
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Country | US
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Telephone | 239-307-5311
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Fax | 239-307-5314
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SLINA CARRERA
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Credential |
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Telephone | 239-307-5311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | NR30211784
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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