Provider Demographics
NPI:1003109281
Name:ST. CHARLES HEALTH & WELLNESS, INC.
Entity Type:Organization
Organization Name:ST. CHARLES HEALTH & WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:M
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-242-5331
Mailing Address - Street 1:15260 SW 280TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8185
Mailing Address - Country:US
Mailing Address - Phone:305-242-5331
Mailing Address - Fax:305-242-5334
Practice Address - Street 1:15260 SW 280TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8185
Practice Address - Country:US
Practice Address - Phone:305-242-5331
Practice Address - Fax:305-242-5334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-22
Last Update Date:2011-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6724261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy