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General NPI Number Information
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NPI Number | 1710406905
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Entity Type | Organization
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Legal Business Name | CG3 ENTERPRISES INC.
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Dates
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Enumeration Date | 09/19/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 10251 W SAMPLE RD STE D
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-3928
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Country | US
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Telephone | 954-507-4530
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Fax |
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Provider Business Mailing Address
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Address Line | 10251 W SAMPLE RD STE D
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-3928
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Country | US
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Telephone | 954-507-4530
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GREG FARIAS
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Credential |
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Telephone | 954-507-4530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 299994695
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License Number State | FL
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