Provider Demographics
NPI:1841235553
Name:GAVE CORPORATION
Entity Type:Organization
Organization Name:GAVE CORPORATION
Other - Org Name:PHYSICIANS AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARICRUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-964-3308
Mailing Address - Street 1:3127 W HALLANDALE BEACH BLVD
Mailing Address - Street 2:#115
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5150
Mailing Address - Country:US
Mailing Address - Phone:954-964-3308
Mailing Address - Fax:954-964-1902
Practice Address - Street 1:3127 W HALLANDALE BEACH BLVD
Practice Address - Street 2:#115
Practice Address - City:HALLANDALE
Practice Address - State:FL
Practice Address - Zip Code:33009-5150
Practice Address - Country:US
Practice Address - Phone:954-964-3308
Practice Address - Fax:954-964-1902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6780207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9244Medicare ID - Type Unspecified