Provider Demographics
NPI:1790239119
Name:CAREATC - CITY OF COCOA
Entity Type:Organization
Organization Name:CAREATC - CITY OF COCOA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PURCHASING AND FACILITI
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUCWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-779-7416
Mailing Address - Street 1:128 LEMON ST
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-7624
Mailing Address - Country:US
Mailing Address - Phone:918-779-7416
Mailing Address - Fax:855-383-3237
Practice Address - Street 1:128 LEMON ST
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7624
Practice Address - Country:US
Practice Address - Phone:918-779-7416
Practice Address - Fax:855-383-3237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care