Provider Demographics
NPI:1053739243
Name:COMMUNITY CARE OF FLOIDA LLC
Entity type:Organization
Organization Name:COMMUNITY CARE OF FLOIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHENETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-282-4330
Mailing Address - Street 1:11601 KEW GARDENS AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2852
Mailing Address - Country:US
Mailing Address - Phone:561-282-4330
Mailing Address - Fax:
Practice Address - Street 1:4601 N CONGRESS AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3228
Practice Address - Country:US
Practice Address - Phone:561-282-4330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty