Provider Demographics
NPI:1639931173
Name:GTG CARE FT LAUDERDALE LLC
Entity Type:Organization
Organization Name:GTG CARE FT LAUDERDALE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:KIDD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:305-439-0263
Mailing Address - Street 1:525 NW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3043
Mailing Address - Country:US
Mailing Address - Phone:305-439-0263
Mailing Address - Fax:786-288-3617
Practice Address - Street 1:3625 W BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33312-1082
Practice Address - Country:US
Practice Address - Phone:305-439-0263
Practice Address - Fax:786-288-3617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care