Provider Demographics
NPI:1912456435
Name:COCONUT GROVE RECOVERY LLC
Entity type:Organization
Organization Name:COCONUT GROVE RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COLLECTION MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PICILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-993-7165
Mailing Address - Street 1:15291 NW 60TH AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2458
Mailing Address - Country:US
Mailing Address - Phone:855-366-5224
Mailing Address - Fax:855-768-4701
Practice Address - Street 1:15291 NW 60TH AVE STE 200
Practice Address - Street 2:STE 200
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2460
Practice Address - Country:US
Practice Address - Phone:855-366-5224
Practice Address - Fax:855-768-4701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D2106134291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D2106134OtherCMS CLIA LICENSE