Healthcare Provider Details

I. General information

NPI: 1538517404
Provider Name (Legal Business Name): FLORIDA LIFE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2477 W 4TH CRT
HIALEAH FL
33010
US

IV. Provider business mailing address

2477 W 4TH CRT
HIALEAH FL
33010
US

V. Phone/Fax

Practice location:
  • Phone: 786-975-4727
  • Fax:
Mailing address:
  • Phone: 786-975-4727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateFL

VIII. Authorized Official

Name: MARIA E ERRASTI
Title or Position: OWNER
Credential:
Phone: 786-975-4127