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General NPI Number Information
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NPI Number | 1598122202
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Entity Type | Organization
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Legal Business Name | C & L HEALTHY SOLUTIONS, LLC
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Dates
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Enumeration Date | 01/26/2016
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Last Update Date | 01/26/2016
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Provider Practice Location Address
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Address Line | 3741 JACOB LOIS DR W
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City | JACKSONVILLE
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State | FL
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Zip | 32218-2972
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Country | US
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Telephone | 904-627-6031
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Fax |
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Provider Business Mailing Address
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Address Line | 8020 MONCRIEF DINSMORE RD
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City | JACKSONVILLE
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State | FL
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Zip | 32219-3602
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Country | US
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Telephone | 904-627-6031
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. GWEN CUNNINGHAM
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Credential | MAOM
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Telephone | 904-627-6031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 219437
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License Number State | FL
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