Healthcare Provider Details

I. General information

NPI: 1811832850
Provider Name (Legal Business Name): CORE LIFE LINK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 MASON AVE
DAYTONA BEACH FL
32117-4612
US

IV. Provider business mailing address

1020 MASON AVE
DAYTONA BEACH FL
32117-4612
US

V. Phone/Fax

Practice location:
  • Phone: 844-444-3897
  • Fax: 833-455-6962
Mailing address:
  • Phone: 844-444-3897
  • Fax: 833-455-6962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MHAI NANG AGRABA
Title or Position: FOUNDER/CEO
Credential: PHARMD
Phone: 386-449-9760