Provider Demographics
NPI:1407486947
Name:CADIEUX PREMIUM HCS FLORIDA, LLC
Entity Type:Organization
Organization Name:CADIEUX PREMIUM HCS FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIROLAMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-874-0238
Mailing Address - Street 1:1661 WILLIAMSBURG SQ
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-4279
Mailing Address - Country:US
Mailing Address - Phone:863-874-0238
Mailing Address - Fax:
Practice Address - Street 1:1661 WILLIAMSBURG SQ
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4279
Practice Address - Country:US
Practice Address - Phone:863-874-0238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL236463OtherAGENCY FOR HEALTH CARE ADMINISTRATION LICENSURE