MEDICARE: THE LIFE OF THE FUTURE MEDICAL CENTER, INC

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	174400000X	Specialist

General Provider Information

NPI Number	:	1467406959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE LIFE OF THE FUTURE MEDICAL CENTER, INC

Provider Business Mailing Address
First Line	:	1170 E HALLANDALE BEACH BLVD
Second Line	:	SUITE 1170C
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-4432
Country	:	US
Telephone Number	:	954-458-1940
Fax Number	:	954-458-1946

Provider Business Practice Location Address
First Line	:	1170 E HALLANDALE BEACH BLVD
Second Line	:	SUITE 1170C
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-4432
Country	:	US
Telephone Number	:	954-458-1940
Fax Number	:	954-458-1946

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MISS JACQUELINE BESSIE ALVA
Credential	:
Telephone Number	:	954-458-1940

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	08/22/2020

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