Basic Information
| Provider Information | |||||||||
| NPI: | 1174983571 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GUIDANCE CARE CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3000 41ST STREET OCEAN | ||||||||
| Address2: | |||||||||
| City: | MARATHON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330502373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054347660 | ||||||||
| FaxNumber: | 3054349040 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 41ST STREET OCEAN | ||||||||
| Address2: | |||||||||
| City: | MARATHON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330502373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054347660 | ||||||||
| FaxNumber: | 3054349040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2016 | ||||||||
| LastUpdateDate: | 04/25/2019 | ||||||||
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| AuthorizedOfficialLastName: | DUNLEAVY | ||||||||
| AuthorizedOfficialFirstName: | MAUREEN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | AREA DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3054347660 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GUIDANCE CARE CENTER, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MA, NCC, LMHC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.