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General NPI Number Information
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NPI Number | 1871317495
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Entity Type | Organization
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Legal Business Name | BALANCE LIFE HEALTH SERVICE LLC
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 5555 HOLLYWOOD BLVD STE 300
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City | HOLLYWOOD
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State | FL
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Zip | 33021-6469
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Country | US
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Telephone | 786-380-8375
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Fax |
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Provider Business Mailing Address
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Address Line | 5555 HOLLYWOOD BLVD STE 300
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City | HOLLYWOOD
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State | FL
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Zip | 33021-6469
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Country | US
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Telephone | 786-380-8375
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAYDIBIS BLANCO ALONSO
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Credential |
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Telephone | 786-380-8375
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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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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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