Healthcare Provider Details

I. General information

NPI: 1003238536
Provider Name (Legal Business Name): LIFE CONCEPTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E COLONIAL DR
ORLANDO FL
32803-4504
US

IV. Provider business mailing address

1509 E COLONIAL DR
ORLANDO FL
32803-4704
US

V. Phone/Fax

Practice location:
  • Phone: 407-218-4340
  • Fax:
Mailing address:
  • Phone: 407-218-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0-13-5630
License Number StateFL

VIII. Authorized Official

Name: BROOKE EAKINS
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 407-218-4356