MEDICARE: LIFEFUL AGING, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	133NN1002X	Nutrition Education Nutritionist
2	133VN1101X	Gerontological Nutrition Registered Dietitian
3	133VN1201X	Obesity and Weight Management Nutrition Registered Dietitian
4	171400000X	Health & Wellness Coach
5	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1437981511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFEFUL AGING, LLC

Provider Business Mailing Address
First Line	:	11211 PROSPERITY FARMS RD STE A101
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-3479
Country	:	US
Telephone Number	:	480-813-9989
Fax Number	:

Provider Business Practice Location Address
First Line	:	11211 PROSPERITY FARMS RD STE A101
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-3479
Country	:	US
Telephone Number	:	480-813-9989
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	BETTY HARBOLIC
Credential	:	MS, RDN
Telephone Number	:	917-449-2990

Provider Enumeration Date	:	08/16/2024
Last Update Date	:	08/21/2024

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Directions to “LIFEFUL AGING, LLC ” Practice Location

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