Healthcare Provider Details
I. General information
NPI: 1801471503
Provider Name (Legal Business Name): LIFE RESOURCES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 03/14/2021
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1157 S STATE ROAD 7
WELLINGTON FL
33414-6101
US
IV. Provider business mailing address
1157 S STATE ROAD 7
WELLINGTON FL
33414-6101
US
V. Phone/Fax
- Phone: 561-234-6599
- Fax: 888-809-1447
- Phone: 561-234-6599
- Fax: 888-809-1447
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207RI0200X |
| Taxonomy | Infectious Disease Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
JON
ARENSTEIN
Title or Position: CEO
Credential: MD
Phone: 561-234-6599