Provider Demographics
NPI:1043664469
Name:NORTH CLEVELAND HEALTHCARE CENTER
Entity type:Organization
Organization Name:NORTH CLEVELAND HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAZARO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFONSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-849-6839
Mailing Address - Street 1:13240 N CLEVELAND AVE
Mailing Address - Street 2:UNIT # 9
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-4855
Mailing Address - Country:US
Mailing Address - Phone:239-652-3783
Mailing Address - Fax:
Practice Address - Street 1:13240 N CLEVELAND AVE
Practice Address - Street 2:UNIT # 9
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-4855
Practice Address - Country:US
Practice Address - Phone:239-652-3783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty