| Healthy Community Center Llc | |
|
506 Se 47th Ter Ste B Cape Coral FL 33904-8593 | |
| (239) 673-9825 | |
| (239) 257-2326 |
| Full Name | Healthy Community Center Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 506 Se 47th Ter Ste B, Cape Coral, Florida |
| Authorized Official Name and Position | Jeff Garcia (PRESIDENT) |
| Authorized Official Contact | 3059891837 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healthy Community Center Llc 506 Se 47th Ter Ste B Cape Coral FL 33904-8593 Ph: (239) 673-9825 | Healthy Community Center Llc 506 Se 47th Ter Ste B Cape Coral FL 33904-8593 Ph: (239) 673-9825 |
| NPI Number | 1023609872 |
|---|---|
| Provider Enumeration Date | 02/02/2021 |
| Last Update Date | 01/16/2024 |
| Certification Date | 01/16/2024 |
| Medicare PECOS PAC ID | 0244630671 |
|---|---|
| Medicare Enrollment ID | O20210607001983 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023609872 | NPI | - | NPPES |
| 109423000 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Jose E Rodriguez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548506553 PECOS PAC ID: 9234438961 Enrollment ID: I20160502002404 |
| Provider Name | Mairelis De La Cruz Hernandez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588295919 PECOS PAC ID: 6305268491 Enrollment ID: I20200618000903 |
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