MEDICARE: FRIENDS FOR LIFE CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1063094068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRIENDS FOR LIFE CENTER

Provider Business Mailing Address
First Line	:	1580 79TH STREET CSWY
Second Line	:
City	:	NORTH BAY VILLAGE
State	:	FL
Zip	:	33141-4131
Country	:	US
Telephone Number	:	786-535-7605
Fax Number	:	786-535-7336

Provider Business Practice Location Address
First Line	:	1580 79TH STREET CSWY
Second Line	:
City	:	NORTH BAY VILLAGE
State	:	FL
Zip	:	33141-4131
Country	:	US
Telephone Number	:	786-535-7605
Fax Number	:	786-535-7336

Authorized Official
Title or Position	:	FINANCIAL OFFICER
Name	:	FAIVISH DENBERG
Credential	:	RABBI
Telephone Number	:	786-269-7837

Provider Enumeration Date	:	04/28/2021
Last Update Date	:	04/28/2021

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