Provider Demographics
NPI:1366085821
Name:COMMUNITY CARE RESOURCES OF FL LLC
Entity type:Organization
Organization Name:COMMUNITY CARE RESOURCES OF FL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:URTEAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-401-7457
Mailing Address - Street 1:15800 PINES BLVD STE 332
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1212
Mailing Address - Country:US
Mailing Address - Phone:954-362-5432
Mailing Address - Fax:866-240-4606
Practice Address - Street 1:675 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2555
Practice Address - Country:US
Practice Address - Phone:407-401-7457
Practice Address - Fax:407-598-0885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2020-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGRANTOtherSTATE OF FLORIDA