MEDICARE: HEALTHY LIFE CHOICE, 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	251E00000X	Home 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	:	1841701612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY LIFE CHOICE, INC.

Provider Business Mailing Address
First Line	:	1775 BAY RIDGE PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-5622
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1775 BAY RIDGE PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-5622
Country	:	US
Telephone Number	:	718-839-0376
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JINGLING TANG
Credential	:	MD
Telephone Number	:	718-839-0376

Provider Enumeration Date	:	10/19/2017
Last Update Date	:	10/19/2017

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