Provider Demographics
NPI:1780197152
Name:COMPLETE CARE MANAGEMENT SERVICES ACO LLC
Entity Type:Organization
Organization Name:COMPLETE CARE MANAGEMENT SERVICES ACO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER-COB
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:ARMANDO
Authorized Official - Last Name:ESPINO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:786-395-1165
Mailing Address - Street 1:6625 MIAMI LAKES DR STE 247
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2768
Mailing Address - Country:US
Mailing Address - Phone:786-292-4797
Mailing Address - Fax:866-317-9048
Practice Address - Street 1:6625 MIAMI LAKES DR STE 247
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2768
Practice Address - Country:US
Practice Address - Phone:786-292-4797
Practice Address - Fax:866-317-9048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty