Provider Demographics
NPI:1558319756
Name:MORSELIFE HOUSING CORPORATION
Entity Type:Organization
Organization Name:MORSELIFE HOUSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-209-6108
Mailing Address - Street 1:4847 DAVID S MACK DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-8023
Mailing Address - Country:US
Mailing Address - Phone:561-209-6123
Mailing Address - Fax:561-209-6355
Practice Address - Street 1:4920 LORING DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-8052
Practice Address - Country:US
Practice Address - Phone:561-209-6123
Practice Address - Fax:561-209-6355
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MORSELIFE HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-04
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4067Medicare ID - Type Unspecified