Provider Demographics
NPI:1497341887
Name:SIMPLE LIFE HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:SIMPLE LIFE HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SIMONE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONACO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-385-4212
Mailing Address - Street 1:4206 DEL PRADO BLVD S
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-7154
Mailing Address - Country:US
Mailing Address - Phone:561-385-4212
Mailing Address - Fax:
Practice Address - Street 1:4206 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-7154
Practice Address - Country:US
Practice Address - Phone:561-385-4212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-19
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty