Provider Demographics
NPI:1215680475
Name:CARE COORDINATION MANAGEMENT GROUP
Entity type:Organization
Organization Name:CARE COORDINATION MANAGEMENT GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSIDENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-539-2680
Mailing Address - Street 1:7775 134TH ST
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3740
Mailing Address - Country:US
Mailing Address - Phone:772-473-4151
Mailing Address - Fax:
Practice Address - Street 1:7775 134TH ST
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3740
Practice Address - Country:US
Practice Address - Phone:772-473-4151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109892700Medicaid