Healthcare Provider Details

I. General information

NPI: 1538504543
Provider Name (Legal Business Name): LIFE SOLUTIONS OUTPATIENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2013
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 NORTHPOINT PKWY STE 304
WEST PALM BEACH FL
33407-1953
US

IV. Provider business mailing address

901 NORTHPOINT PKWY STE 304
WEST PALM BEACH FL
33407-1953
US

V. Phone/Fax

Practice location:
  • Phone: 954-678-0078
  • Fax: 954-370-6447
Mailing address:
  • Phone: 954-678-0078
  • Fax: 954-370-6447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MARK SEIFERT
Title or Position: OFFICE MANAGER
Credential:
Phone: 954-678-0078