Basic Information
Provider Information
NPI: 1407270770
EntityType: 2
ReplacementNPI:  
OrganizationName: GUIDANCE CARE CENTER
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3000 41ST STREET OCEAN
Address2:  
City: MARATHON
State: FL
PostalCode: 330502373
CountryCode: US
TelephoneNumber: 3054347660
FaxNumber: 3054349041
Practice Location
Address1: 3000 41ST STREET OCEAN
Address2:  
City: MARATHON
State: FL
PostalCode: 330502373
CountryCode: US
TelephoneNumber: 3054347660
FaxNumber: 3054349041
Other Information
ProviderEnumerationDate: 02/07/2014
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: BOWEN
AuthorizedOfficialFirstName: CINDEE
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: RN
AuthorizedOfficialTelephone: 3054347660
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: WESTCARE
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251S00000X FLY AgenciesCommunity/Behavioral Health 

No ID Information.


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