MEDICARE: EMBRACE LIFE, LLC

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1427693019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMBRACE LIFE, LLC

Provider Business Mailing Address
First Line	:	8521 ARLINGTON DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-4752
Country	:	US
Telephone Number	:	405-473-2847
Fax Number	:

Provider Business Practice Location Address
First Line	:	8521 ARLINGTON DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-4752
Country	:	US
Telephone Number	:	405-473-2847
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. AVIS BRAY
Credential	:
Telephone Number	:	405-473-2847

Provider Enumeration Date	:	11/07/2019
Last Update Date	:	11/07/2019

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