Organization
STAYWELL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA CRUZ LMT (OWNER)
(561) 303-8903
Entity
Organization
Contact information
Practice address
5300 W 16TH AVE, 106, HIALEAH, FL 33012-2104
(561) 303-8903
Mailing address
9769 ARBOR OAKS LN, 204, BOCA RATON, FL 33428-2212
(561) 303-8903
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
AP2024
FL
302R00000X
Health Maintenance Organization
MA60818
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1578637948
APOMD
FL
01
—
1972898989
LMT
FL
Enumeration date
06/16/2014
Last updated
06/16/2014
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