Provider Demographics
NPI:1811401805
Name:CCG PALLIATIVE CARE SERVICES, LLC
Entity Type:Organization
Organization Name:CCG PALLIATIVE CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:B
Authorized Official - Last Name:PEREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-255-7310
Mailing Address - Street 1:8251 W BROWARD BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2703
Mailing Address - Country:US
Mailing Address - Phone:954-255-7310
Mailing Address - Fax:954-255-7311
Practice Address - Street 1:8251 W BROWARD BLVD STE 103
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2703
Practice Address - Country:US
Practice Address - Phone:954-255-7310
Practice Address - Fax:954-255-7311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104716207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty