Organization
COCONUT GROVE RECOVERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CATHY PICILLO (BILLING COLLECTION MANAGER)
(954) 993-7165
Entity
Organization
Contact information
Practice address
15291 NW 60TH AVE STE 200, STE 200, MIAMI LAKES, FL 33014-2460
(855) 366-5224
(855) 768-4701
Mailing address
15291 NW 60TH AVE, STE 200, MIAMI LAKES, FL 33014-2458
(855) 366-5224
(855) 768-4701
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
10D2106134
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10D2106134
CMS CLIA LICENSE
FL
Enumeration date
09/26/2016
Last updated
09/26/2016
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