Healthcare Provider Details

I. General information

NPI: 1659617371
Provider Name (Legal Business Name): HAPPINESS LIFE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2012
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 DUNLAWTON AVE SUITE D
PORT ORANGE FL
32127-4223
US

IV. Provider business mailing address

840 DUNLAWTON AVE SUITE D
PORT ORANGE FL
32127-4223
US

V. Phone/Fax

Practice location:
  • Phone: 386-868-3892
  • Fax: 386-506-8255
Mailing address:
  • Phone: 386-868-3892
  • Fax: 386-506-8255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9213
License Number StateFL

VIII. Authorized Official

Name: MR. STEVEN M KATZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 386-868-3892