Healthcare Provider Details

I. General information

NPI: 1174816920
Provider Name (Legal Business Name): LIFESTAR CASE MANAGEMENT SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3414 W 84TH ST STE D110
HIALEAH FL
33018-4932
US

IV. Provider business mailing address

3414 W 84TH ST STE D110
HIALEAH FL
33018-4932
US

V. Phone/Fax

Practice location:
  • Phone: 305-825-4320
  • Fax: 305-825-8117
Mailing address:
  • Phone: 305-825-4320
  • Fax: 305-825-8117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNY A BERNAL
Title or Position: OWNER
Credential: RMHI
Phone: 786-303-5079