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General NPI Number Information
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NPI Number | 1285976340
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Entity Type | Organization
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Legal Business Name | EXCELLENT LIFE DESIGN CORPORATION
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 1540 INTERNATIONAL PKWY SUITE 2000
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City | LAKE MARY
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State | FL
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Zip | 32746-5096
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Country | US
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Telephone | 407-536-5120
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Fax | 810-222-0685
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Provider Business Mailing Address
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Address Line | 1540 INTERNATIONAL PKWY SUITE 2000
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City | LAKE MARY
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State | FL
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Zip | 32746-5096
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Country | US
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Telephone | 407-536-5120
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Fax | 810-222-0685
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Authorized Official
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Title or Position | CEO
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Name | RHONDA BAKER
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Credential |
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Telephone | 407-536-5120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MT2629
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License Number State | FL
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