Provider Demographics
NPI:1568979466
Name:ENDURING LIFE SERVICES LLC
Entity Type:Organization
Organization Name:ENDURING LIFE SERVICES LLC
Other - Org Name:HARMONYONE ALF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CUBBERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-385-8046
Mailing Address - Street 1:11972 ORANGE BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-3443
Mailing Address - Country:US
Mailing Address - Phone:727-385-8046
Mailing Address - Fax:
Practice Address - Street 1:11972 ORANGE BLOSSOM DR
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-3443
Practice Address - Country:US
Practice Address - Phone:727-385-8046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENDURING LIFE SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL13060310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022639100Medicaid