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General NPI Number Information
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NPI Number | 1023208972
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Entity Type | Organization
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Legal Business Name | INDEPENDENT LIFE LLC
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 01/02/2010
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Provider Practice Location Address
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Address Line | 4047 OCKEECHOBEE BLVD. STE 123
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-3236
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Country | US
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Telephone | 561-385-0868
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Fax |
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Provider Business Mailing Address
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Address Line | 4047 OCKEECHOBEE BLVD. STE 123
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-3236
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Country | US
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Telephone | 561-385-0868
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED.REPRESENTATIVE
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Name | MRS. PRINCE E. GREEN
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Credential | O.T
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Telephone | 561-385-0868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State | FL
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