Provider Demographics
NPI:1871310086
Name:SOUTH FLORIDA COMMUNITY CARE NETWORK, LLC
Entity type:Organization
Organization Name:SOUTH FLORIDA COMMUNITY CARE NETWORK, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP & CHIEF BUSINESS DEV OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUPE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-622-3237
Mailing Address - Street 1:1643 HARRISON PKWY STE H-200
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-3091
Mailing Address - Country:US
Mailing Address - Phone:954-622-3200
Mailing Address - Fax:
Practice Address - Street 1:1643 HARRISON PKWY STE H-200
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-3091
Practice Address - Country:US
Practice Address - Phone:954-622-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH FLORIDA COMMUNITY CARE NETWORK, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1232287-07Medicaid