Provider Demographics
NPI:1770569220
Name:FLORIDA CARE LEVEL MANAGEMENT DIRECT, LLC
Entity type:Organization
Organization Name:FLORIDA CARE LEVEL MANAGEMENT DIRECT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAOUF
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-591-3435
Mailing Address - Street 1:3550 BUSCHWOOD PARK DR
Mailing Address - Street 2:SUITE 133
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4461
Mailing Address - Country:US
Mailing Address - Phone:813-932-3741
Mailing Address - Fax:813-932-3992
Practice Address - Street 1:23622 CALABASAS RD
Practice Address - Street 2:STE 250
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1549
Practice Address - Country:US
Practice Address - Phone:818-591-3435
Practice Address - Fax:818-591-3440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K8806Medicare UPIN