Provider Demographics
NPI:1326119561
Name:FAMILY LIFE MINISTRIES OF NW FLORIDA
Entity Type:Organization
Organization Name:FAMILY LIFE MINISTRIES OF NW FLORIDA
Other - Org Name:SOZO LIFE CONNECTION
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:STROCK
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:850-862-5455
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32549-0250
Mailing Address - Country:US
Mailing Address - Phone:850-862-5455
Mailing Address - Fax:850-862-6855
Practice Address - Street 1:419 RACETRACK RD NW STE A
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-4612
Practice Address - Country:US
Practice Address - Phone:850-862-5455
Practice Address - Fax:850-862-6855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory