Provider Demographics
NPI:1871264507
Name:HEART & LIFE COMMUNITY CENTER INC
Entity Type:Organization
Organization Name:HEART & LIFE COMMUNITY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CCMS
Authorized Official - Phone:407-730-5306
Mailing Address - Street 1:801 N MAGNOLIA AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3842
Mailing Address - Country:US
Mailing Address - Phone:407-730-5306
Mailing Address - Fax:407-730-5305
Practice Address - Street 1:309 NE 1ST ST STE B
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-5310
Practice Address - Country:US
Practice Address - Phone:407-730-5306
Practice Address - Fax:407-730-5305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109829400Medicaid