Provider Demographics
NPI:1659813764
Name:LIFEFORCE HEALTH GROUP, LLC
Entity Type:Organization
Organization Name:LIFEFORCE HEALTH GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-849-1309
Mailing Address - Street 1:2625 MCCORMICK DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-1077
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2625 MCCORMICK DR
Practice Address - Street 2:SUITE 105
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1077
Practice Address - Country:US
Practice Address - Phone:727-849-1309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies