Provider Demographics
NPI:1861778896
Name:FLORIDA CARE CENTER WINTER GARDEN, LLC
Entity type:Organization
Organization Name:FLORIDA CARE CENTER WINTER GARDEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:J
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-888-2210
Mailing Address - Street 1:PO BOX 144176
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33114-4176
Mailing Address - Country:US
Mailing Address - Phone:305-888-2210
Mailing Address - Fax:305-443-6061
Practice Address - Street 1:319 S DILLARD ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3524
Practice Address - Country:US
Practice Address - Phone:404-574-6969
Practice Address - Fax:407-574-7076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-21
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN411261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center