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General NPI Number Information
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NPI Number | 1205016490
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Entity Type | Organization
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Legal Business Name | LIFE INDIVIDUAL FAMILY ENRICHMENT SERVICES
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Dates
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Enumeration Date | 11/06/2007
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 153 WHITE FAWN DR
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-1464
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Country | US
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Telephone | 386-523-8287
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Fax | 386-523-8287
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Provider Business Mailing Address
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Address Line | 153 WHITE FAWN DR
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-1464
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Country | US
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Telephone | 386-523-8287
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Fax | 386-523-8287
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Authorized Official
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Title or Position | DIRECTOR
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Name | JERRY LEWIS TAYLOR
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Credential |
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Telephone | 386-523-8287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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