Provider Demographics
NPI: | 1457005696 |
---|---|
Name: | CHIEF CARE LLC |
Entity Type: | Organization |
Organization Name: | CHIEF CARE LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MEMBER/OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SHEREEN-GALE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MARSH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RN |
Authorized Official - Phone: | 954-716-6790 |
Mailing Address - Street 1: | 7378 W ATLANTIC BLVD # 228 |
Mailing Address - Street 2: | |
Mailing Address - City: | MARGATE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33063-4214 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3601 W COMMERCIAL BLVD STE 16 |
Practice Address - Street 2: | |
Practice Address - City: | FORT LAUDERDALE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33309-3320 |
Practice Address - Country: | US |
Practice Address - Phone: | 954-716-6790 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-02-07 |
Last Update Date: | 2022-02-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 163WI0500X | Nursing Service Providers | Registered Nurse | Infusion Therapy | Group - Multi-Specialty |
No | 291U00000X | Laboratories | Clinical Medical Laboratory | Group - Multi-Specialty |