Provider Demographics
NPI:1801209366
Name:LIFE HEALTHCARE SERVICES, INC.
Entity Type:Organization
Organization Name:LIFE HEALTHCARE SERVICES, INC.
Other - Org Name:LIFE HEALTHCARE SERVICES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-826-5757
Mailing Address - Street 1:2170 W 73RD ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1820
Mailing Address - Country:US
Mailing Address - Phone:305-826-5757
Mailing Address - Fax:305-826-5767
Practice Address - Street 1:2170 W 73RD ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1820
Practice Address - Country:US
Practice Address - Phone:305-826-5757
Practice Address - Fax:305-826-5767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH281593336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146076OtherPK