=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639245145
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PURE LIFE GROUP SERVICES,CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1393 SW 1ST ST SUITE 207
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33135-2321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-642-8830
-----------------------------------------------------
Fax | 305-642-8831
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1393 SW 1ST ST SUITE 207
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33135-2321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-642-8830
-----------------------------------------------------
Fax | 305-642-8831
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MARIA L MARINA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-642-8830
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------