Provider Demographics
NPI:1447299235
Name:CC-AVENTURA, INC
Entity type:Organization
Organization Name:CC-AVENTURA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-692-4710
Mailing Address - Street 1:19333 W COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2485
Mailing Address - Country:US
Mailing Address - Phone:305-692-4700
Mailing Address - Fax:305-692-4706
Practice Address - Street 1:19333 W COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2485
Practice Address - Country:US
Practice Address - Phone:305-692-4700
Practice Address - Fax:305-692-4706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2812350140080OtherFOLIO