Provider Demographics
NPI:1013269851
Name:COMPREHENSIVE CARE CENTER INC NORTH PORT
Entity Type:Organization
Organization Name:COMPREHENSIVE CARE CENTER INC NORTH PORT
Other - Org Name:COMMUNITY AIDS NETWORK, NORTH PORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CUFFAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-366-0134
Mailing Address - Street 1:14243 TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-2215
Mailing Address - Country:US
Mailing Address - Phone:941-366-0134
Mailing Address - Fax:941-951-1795
Practice Address - Street 1:1231 N TUTTLE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-3116
Practice Address - Country:US
Practice Address - Phone:941-366-0134
Practice Address - Fax:941-951-1795
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPREHENSIVE CARE CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057256000Medicaid
FL057256000Medicaid