Healthcare Provider Details

I. General information

NPI: 1598925141
Provider Name (Legal Business Name): FOUDATION FOR BETTER LIVING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2612 29TH ST SW
LEHIGH ACRES FL
33976-4076
US

IV. Provider business mailing address

2612 29TH ST SW
LEHIGH ACRES FL
33976-4076
US

V. Phone/Fax

Practice location:
  • Phone: 239-303-1689
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number089319
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number089319
License Number StateFL

VIII. Authorized Official

Name: EDUARDO LOPEZ
Title or Position: DIRECTOR
Credential:
Phone: 239-303-1689