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General NPI Number Information
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NPI Number | 1750744785
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Entity Type | Organization
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Legal Business Name | CG2 HOLDINGS, INC.
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Dates
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Enumeration Date | 03/29/2016
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 402 WILMA ST
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City | LONGWOOD
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State | FL
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Zip | 32750-4114
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Country | US
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Telephone | 407-415-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 22 WINDSOR ISLE DR
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City | LONGWOOD
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State | FL
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Zip | 32779-9755
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Country | US
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Telephone | 407-415-7246
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. CINDY GRAY
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Credential | R.N.
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Telephone | 407-415-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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