Provider Demographics
NPI:1033228648
Name:LIFEWORKS WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:LIFEWORKS WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:I
Authorized Official - Last Name:MINKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-466-6789
Mailing Address - Street 1:301 TURNER ST.
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-5326
Mailing Address - Country:US
Mailing Address - Phone:727-466-6789
Mailing Address - Fax:727-451-1010
Practice Address - Street 1:301 TURNER ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5326
Practice Address - Country:US
Practice Address - Phone:727-466-6789
Practice Address - Fax:727-451-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33369OtherBLUE CROSS/BLUE SHIELD
FL33369OtherBLUE CROSS/BLUE SHIELD