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General NPI Number Information
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NPI Number | 1912456435
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Entity Type | Organization
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Legal Business Name | COCONUT GROVE RECOVERY LLC
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Dates
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Enumeration Date | 09/26/2016
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Last Update Date | 09/26/2016
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Provider Practice Location Address
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Address Line | 15291 NW 60TH AVE STE 200 STE 200
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2460
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Country | US
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Telephone | 855-366-5224
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Fax | 855-768-4701
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Provider Business Mailing Address
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Address Line | 15291 NW 60TH AVE STE 200
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2458
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Country | US
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Telephone | 855-366-5224
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Fax | 855-768-4701
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Authorized Official
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Title or Position | BILLING COLLECTION MANAGER
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Name | CATHY PICILLO
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Credential |
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Telephone | 954-993-7165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 10D2106134
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License Number State | FL
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