Provider Demographics
NPI:1003271479
Name:FIT FOR LIFE MINISTRIES INC
Entity Type:Organization
Organization Name:FIT FOR LIFE MINISTRIES INC
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:BLOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:PROFESSIONAL TRAINER
Authorized Official - Phone:318-347-2208
Mailing Address - Street 1:600 COMMON ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-3432
Mailing Address - Country:US
Mailing Address - Phone:318-347-2208
Mailing Address - Fax:
Practice Address - Street 1:600 COMMON ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-3432
Practice Address - Country:US
Practice Address - Phone:318-347-2208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty