=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578510129
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFE BEAT CMHC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2006
-----------------------------------------------------
Last Update Date | 12/04/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6043 NW 167TH ST A-27
-----------------------------------------------------
City | MIAMI LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33015-4326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-556-2606
-----------------------------------------------------
Fax | 305-556-2608
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6043 NW 167TH ST A-27
-----------------------------------------------------
City | MIAMI LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33015-4326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-556-2606
-----------------------------------------------------
Fax | 305-556-2608
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. RAUL VILLA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-556-2606
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | 261QM0801X
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------