Healthcare Provider Details

I. General information

NPI: 1558319756
Provider Name (Legal Business Name): MORSELIFE HOUSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 LORING DR
WEST PALM BEACH FL
33417-8052
US

IV. Provider business mailing address

4847 DAVID S MACK DR
WEST PALM BEACH FL
33417-8023
US

V. Phone/Fax

Practice location:
  • Phone: 561-209-6123
  • Fax: 561-209-6355
Mailing address:
  • Phone: 561-209-6123
  • Fax: 561-209-6355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: RANDY WOLAN
Title or Position: CONTROLLER
Credential:
Phone: 561-209-6108