MEDICARE: LIFE BEAT CMHC INC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	261QM0801X	FL

General Provider Information

NPI Number	:	1578510129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE BEAT CMHC INC

Provider Business Mailing Address
First Line	:	6043 NW 167TH ST
Second Line	:	A-27
City	:	MIAMI LAKES
State	:	FL
Zip	:	33015-4326
Country	:	US
Telephone Number	:	305-556-2606
Fax Number	:	305-556-2608

Provider Business Practice Location Address
First Line	:	6043 NW 167TH ST
Second Line	:	A-27
City	:	MIAMI LAKES
State	:	FL
Zip	:	33015-4326
Country	:	US
Telephone Number	:	305-556-2606
Fax Number	:	305-556-2608

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RAUL VILLA
Credential	:
Telephone Number	:	305-556-2606

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	12/04/2007

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Directions to “LIFE BEAT CMHC INC ” Practice Location

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