Provider Demographics
NPI:1295383032
Name:LIFE SUPPORT COMMUNITY SERVICE INC
Entity Type:Organization
Organization Name:LIFE SUPPORT COMMUNITY SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ ABREU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-690-2148
Mailing Address - Street 1:782 NW 42ND AVE STE 348
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5550
Mailing Address - Country:US
Mailing Address - Phone:305-690-2148
Mailing Address - Fax:
Practice Address - Street 1:782 NW 42ND AVE STE 348
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5550
Practice Address - Country:US
Practice Address - Phone:305-690-2148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health