MEDICARE: LIFE HEALTH WELLNESS CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407481781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE HEALTH WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	2736 SW 137TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-6638
Country	:	US
Telephone Number	:	305-879-3339
Fax Number	:

Provider Business Practice Location Address
First Line	:	2736 SW 137TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-6638
Country	:	US
Telephone Number	:	305-879-3339
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PABLO MORALES CALAFE
Credential	:
Telephone Number	:	305-879-3339

Provider Enumeration Date	:	03/07/2020
Last Update Date	:	03/07/2020

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