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General NPI Number Information
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NPI Number | 1437773280
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Entity Type | Organization
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Legal Business Name | LIVE LOVE LIFE, INC
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Dates
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Enumeration Date | 06/07/2020
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Last Update Date | 04/25/2024
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Provider Practice Location Address
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Address Line | 1702 RIDGEWOOD AVE STE J
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City | HOLLY HILL
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State | FL
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Zip | 32117-1783
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Country | US
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Telephone | 904-458-5444
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Fax | 386-760-7649
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Provider Business Mailing Address
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Address Line | 1700 RIDGEWOOD AVE STE I
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City | HOLLY HILL
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State | FL
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Zip | 32117-1782
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Country | US
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Telephone | 904-458-5444
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Fax | 386-760-7649
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MR. MARK A. WALCZYK
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Credential |
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Telephone | 585-233-0105
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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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Taxonomy #2
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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Taxonomy #3
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Taxonomy Code | 261QP0905X
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Taxonomy Name | State or Local Public Health Clinic/Center
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Taxonomy #4
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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