Healthcare Provider Details

I. General information

NPI: 1467018085
Provider Name (Legal Business Name): LIFE IS A DREAM ADC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5171 MARINER BLVD
SPRING HILL FL
34609-1833
US

IV. Provider business mailing address

5171 MARINER BLVD
SPRING HILL FL
34609-1833
US

V. Phone/Fax

Practice location:
  • Phone: 786-461-8471
  • Fax: 352-340-5679
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARILEY PADRON BRITO
Title or Position: ADMINISTRATOR
Credential:
Phone: 786-461-8471