Healthcare Provider Details

I. General information

NPI: 1891231239
Provider Name (Legal Business Name): CARE FOR LIFE HOMECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 55TH ST
WEST PALM BEACH FL
33407-2611
US

IV. Provider business mailing address

729 55TH ST
WEST PALM BEACH FL
33407-2611
US

V. Phone/Fax

Practice location:
  • Phone: 561-908-1485
  • Fax:
Mailing address:
  • Phone: 561-908-1485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number234663
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number234663
License Number StateFL

VIII. Authorized Official

Name: SHANICA BRYANT
Title or Position: OWNER
Credential:
Phone: 561-908-1485