MEDICARE: C & L HEALTHY SOLUTIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302R00000X	Health Maintenance Organization	219437	FL

General Provider Information

NPI Number	:	1598122202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C & L HEALTHY SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	8020 MONCRIEF DINSMORE RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-3602
Country	:	US
Telephone Number	:	904-627-6031
Fax Number	:

Provider Business Practice Location Address
First Line	:	3741 JACOB LOIS DR W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-2972
Country	:	US
Telephone Number	:	904-627-6031
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. GWEN CUNNINGHAM
Credential	:	MAOM
Telephone Number	:	904-627-6031

Provider Enumeration Date	:	01/26/2016
Last Update Date	:	01/26/2016

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