Provider Demographics
NPI:1043459605
Name:YOUR LIFE'S CHOICES, INC. OF CENTRAL FLORIDA
Entity Type:Organization
Organization Name:YOUR LIFE'S CHOICES, INC. OF CENTRAL FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LENNY
Authorized Official - Middle Name:S
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-868-2779
Mailing Address - Street 1:12615 COLLEGE HILL DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-1849
Mailing Address - Country:US
Mailing Address - Phone:727-868-2779
Mailing Address - Fax:727-869-0633
Practice Address - Street 1:12615 COLLEGE HILL DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-1849
Practice Address - Country:US
Practice Address - Phone:727-868-2779
Practice Address - Fax:727-869-0633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL682951196251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL682951196Medicaid
FL229763OtherAHCA HOMEMAKER & COMPANION SERVICES
FL682951198Medicaid