Healthcare Provider Details

I. General information

NPI: 1861988818
Provider Name (Legal Business Name): LIFE'S SECRET CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16570 SW 70TH ST
MIAMI FL
33193-4492
US

IV. Provider business mailing address

16570 SW 70TH ST
MIAMI FL
33193-4492
US

V. Phone/Fax

Practice location:
  • Phone: 786-620-0830
  • Fax:
Mailing address:
  • Phone: 786-620-0830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MAYRELIS DELGADO
Title or Position: PRESIDENT
Credential:
Phone: 786-620-0830