Healthcare Provider Details

I. General information

NPI: 1245852383
Provider Name (Legal Business Name): LIFETIME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 NW 107TH AVE STE 104
MIAMI FL
33172-3104
US

IV. Provider business mailing address

730 NW 107TH AVE STE 104
MIAMI FL
33172-3104
US

V. Phone/Fax

Practice location:
  • Phone: 305-307-1911
  • Fax: 305-351-8494
Mailing address:
  • Phone: 305-307-1911
  • Fax: 305-351-8494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ADRIAN A ALVAREZ BOSCH
Title or Position: OFFICER
Credential:
Phone: 305-307-1911