Healthcare Provider Details

I. General information

NPI: 1770327454
Provider Name (Legal Business Name): LIFE BALANCE SUPPORT SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 HOLLYWOOD BLVD STE 401
HOLLYWOOD FL
33020-6775
US

IV. Provider business mailing address

2131 HOLLYWOOD BLVD STE 401
HOLLYWOOD FL
33020-6775
US

V. Phone/Fax

Practice location:
  • Phone: 786-208-9094
  • Fax: 305-422-9029
Mailing address:
  • Phone: 954-366-9888
  • Fax: 305-422-9029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSE A MONTES SANTANA
Title or Position: PRESIDENT
Credential: LMHC
Phone: 954-366-9888