Provider Demographics
NPI:1174255863
Name:LIFEMAX MEDICAL SUPPORT CENTER LLC
Entity Type:Organization
Organization Name:LIFEMAX MEDICAL SUPPORT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-900-8330
Mailing Address - Street 1:2260 PALM BEACH LAKES BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-3411
Mailing Address - Country:US
Mailing Address - Phone:321-900-8330
Mailing Address - Fax:
Practice Address - Street 1:2260 PALM BEACH LAKES BLVD STE 212
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-3411
Practice Address - Country:US
Practice Address - Phone:321-900-8330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty