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General NPI Number Information
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NPI Number | 1184311813
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Entity Type | Organization
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Legal Business Name | HEALTHY LIFE GOURMET LLC
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Dates
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Enumeration Date | 04/21/2023
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Last Update Date | 04/21/2023
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Provider Practice Location Address
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Address Line | 126 SE 37TH PL # 126
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City | HOMESTEAD
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State | FL
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Zip | 33033-6216
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Country | US
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Telephone | 786-829-9209
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Fax | 305-230-7546
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Provider Business Mailing Address
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Address Line | 22708 SW 94TH PATH
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City | CUTLER BAY
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State | FL
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Zip | 33190-1266
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Country | US
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Telephone | 178-682-9920
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. LIANET BARRIOS
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Credential |
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Telephone | 786-829-9209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332U00000X
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Taxonomy Name | Home Delivered Meals
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License Number |
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License Number State |
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