=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497640494
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CG SENIOR SERVICES, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2025
-----------------------------------------------------
Last Update Date | 06/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3005 S CONGRESS AVE
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33426-9045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-336-4958
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 190 SPYGLASS LN
-----------------------------------------------------
City | JUPITER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33477-4037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-315-4379
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | PAMLER E GOZZO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-315-4379
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------