Provider Demographics
NPI:1679234843
Name:FLORIDA COMMUNITY CARE LLC
Entity Type:Organization
Organization Name:FLORIDA COMMUNITY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NESTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:PLANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-262-1292
Mailing Address - Street 1:4601 NW 77TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6449
Mailing Address - Country:US
Mailing Address - Phone:305-262-1292
Mailing Address - Fax:
Practice Address - Street 1:4601 NW 77TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166-6449
Practice Address - Country:US
Practice Address - Phone:305-262-1292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1000530-06Medicaid