Provider Demographics
NPI:1568029718
Name:HEALTHY LIFE ENTERPRISES LLC
Entity Type:Organization
Organization Name:HEALTHY LIFE ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-906-4141
Mailing Address - Street 1:6041 KIMBERLY BLVD STE K
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-2816
Mailing Address - Country:US
Mailing Address - Phone:954-906-4141
Mailing Address - Fax:
Practice Address - Street 1:6041 KIMBERLY BLVD STE K
Practice Address - Street 2:
Practice Address - City:NORTH LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33068-2816
Practice Address - Country:US
Practice Address - Phone:954-906-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory