Organization
CLUB COMMUNITY CARE LLC
Active
Organization
CLUB COMMUNITY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAMARY DIAZ HERNANDEZ (PRESIDENT)
(786) 497-1134
Entity
Organization
Contact information
Practice address
164 NW MADISON ST, LAKE CITY, FL 32055-3904
(786) 587-9814
Mailing address
164 NW MADISON ST, LAKE CITY, FL 32055-3904
(786) 587-9814
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
12/10/2020
Last updated
12/10/2020
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