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General NPI Number Information
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NPI Number | 1528506458
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE LIFE SOUTIONS
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Dates
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Enumeration Date | 02/11/2017
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 4040 SW 84TH TER
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City | DAVIE
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State | FL
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Zip | 33328-2951
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Country | US
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Telephone | 954-637-3167
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Fax |
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Provider Business Mailing Address
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Address Line | 4040 SW 84TH TER
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City | DAVIE
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State | FL
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Zip | 33328-2951
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Country | US
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Telephone | 954-637-3167
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAIDYS ROQUE
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Credential | PHARMD
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Telephone | 954-637-3167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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