Provider Demographics
NPI:1952712713
Name:CNS HOLDING COMPANY LLC
Entity Type:Organization
Organization Name:CNS HOLDING COMPANY LLC
Other - Org Name:WILLISTON RURAL HEALTH AND WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:SPOGEN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:352-572-0666
Mailing Address - Street 1:1300 SW 42ND ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-1366
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 NW 1ST AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696-2006
Practice Address - Country:US
Practice Address - Phone:352-529-0966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health