Provider Demographics
NPI:1710412804
Name:FLORIDA LIFE RECOVERY AND REHABILITATION LLC
Entity Type:Organization
Organization Name:FLORIDA LIFE RECOVERY AND REHABILITATION LLC
Other - Org Name:PACHECO MEDICAL CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PACHECO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-960-7104
Mailing Address - Street 1:590 E 49TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-1962
Mailing Address - Country:US
Mailing Address - Phone:786-409-4313
Mailing Address - Fax:305-397-2502
Practice Address - Street 1:590 E 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1962
Practice Address - Country:US
Practice Address - Phone:786-409-4313
Practice Address - Fax:305-397-2502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)