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General NPI Number Information
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NPI Number | 1093521908
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Entity Type | Organization
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Legal Business Name | COMMUNITY LIFE SUPPORT,INC
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Dates
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Enumeration Date | 12/05/2024
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 486 FISHERMAN ST
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City | OPA LOCKA
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State | FL
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Zip | 33054-3818
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Country | US
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Telephone | 305-688-5456
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Fax | 305-688-1661
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Provider Business Mailing Address
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Address Line | 486 FISHERMAN ST
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City | OPA LOCKA
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State | FL
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Zip | 33054-3818
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Country | US
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Telephone | 305-688-5456
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Fax | 305-688-1661
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Authorized Official
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Title or Position | MANAGER
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Name | YADIRA I MUNOZ
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Credential |
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Telephone | 305-505-7518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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