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General NPI Number Information
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NPI Number | 1619580669
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Entity Type | Organization
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Legal Business Name | LIFELINE COMMUNITY SUPPORT, LLC
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Dates
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Enumeration Date | 08/28/2020
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Last Update Date | 08/18/2021
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Provider Practice Location Address
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Address Line | 1666 79TH STREET CSWY STE 603
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City | NORTH BAY VILLAGE
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State | FL
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Zip | 33141-4190
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Country | US
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Telephone | 178-651-8893
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Fax | 786-254-7303
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Provider Business Mailing Address
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Address Line | 1666 79TH STREET CSWY STE 603
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City | NORTH BAY VILLAGE
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State | FL
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Zip | 33141-4190
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Country | US
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Telephone | 786-518-8931
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SERGIO ALEJANDRO VILLATORO
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Credential | BHCM
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Telephone | 786-518-8931
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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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