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General NPI Number Information
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NPI Number | 1275036550
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Entity Type | Organization
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Legal Business Name | LONG LIFE BEHAVIORAL SERVICES INC
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Dates
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Enumeration Date | 03/13/2018
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Last Update Date | 03/13/2018
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Provider Practice Location Address
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Address Line | 9050 PINES BLVD STE 355
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6422
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Country | US
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Telephone | 786-660-0886
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Fax |
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Provider Business Mailing Address
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Address Line | 8897 FONTAINEBLEAU BLVD APT 202
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City | MIAMI
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State | FL
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Zip | 33172-4430
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS ILEANA ALVAREZ VELAZQUEZ
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Credential |
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Telephone | 786-660-0886
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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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