MEDICARE: WORKLIFE SUPPORT SERVICES

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	:	1821287947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WORKLIFE SUPPORT SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 212665
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33421-2665
Country	:	US
Telephone Number	:
Fax Number	:	561-656-1828

Provider Business Practice Location Address
First Line	:	2003 RESTON CIR
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-6109
Country	:	US
Telephone Number	:	561-714-9960
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. HENRY WALTER HASTON JR.
Credential	:
Telephone Number	:	561-714-9960

Provider Enumeration Date	:	10/15/2007
Last Update Date	:	10/15/2007

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