Provider Demographics
NPI:1578510129
Name:LIFE BEAT CMHC INC
Entity Type:Organization
Organization Name:LIFE BEAT CMHC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-556-2606
Mailing Address - Street 1:6043 NW 167TH ST
Mailing Address - Street 2:A-27
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4326
Mailing Address - Country:US
Mailing Address - Phone:305-556-2606
Mailing Address - Fax:305-556-2608
Practice Address - Street 1:6043 NW 167TH ST
Practice Address - Street 2:A-27
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33015-4326
Practice Address - Country:US
Practice Address - Phone:305-556-2606
Practice Address - Fax:305-556-2608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QM0801X261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101431Medicare Oscar/Certification