Provider Demographics
NPI:1598122202
Name:C & L HEALTHY SOLUTIONS, LLC
Entity Type:Organization
Organization Name:C & L HEALTHY SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MAOM
Authorized Official - Phone:904-627-6031
Mailing Address - Street 1:8020 MONCRIEF DINSMORE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32219-3602
Mailing Address - Country:US
Mailing Address - Phone:904-627-6031
Mailing Address - Fax:
Practice Address - Street 1:3741 JACOB LOIS DR W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-2972
Practice Address - Country:US
Practice Address - Phone:904-627-6031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL219437302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization