Healthcare Provider Details

I. General information

NPI: 1649248733
Provider Name (Legal Business Name): LIFE LONG LEARNING CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1699 SW SOUTHWORTH TER
PORT ST LUCIE FL
34953-1012
US

IV. Provider business mailing address

1699 SW SOUTHWORTH TER
PORT ST LUCIE FL
34953-1012
US

V. Phone/Fax

Practice location:
  • Phone: 772-340-0594
  • Fax: 772-304-0594
Mailing address:
  • Phone: 772-340-0594
  • Fax: 772-340-0594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2278C0205X
TaxonomyCritical Care Certified Respiratory Therapist
License Number
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2278E0002X
TaxonomyEmergency Care Certified Respiratory Therapist
License Number
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. CHARLES HOWARD SWIHART
Title or Position: RESPIRATORY THERAPIST
Credential: CRTT
Phone: 772-340-0594