Provider Demographics
NPI:1134869225
Name:EASY LIFE HOME CARE
Entity type:Organization
Organization Name:EASY LIFE HOME CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIA
Authorized Official - Middle Name:V
Authorized Official - Last Name:BOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-350-1238
Mailing Address - Street 1:PO BOX 360091
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32936-0091
Mailing Address - Country:US
Mailing Address - Phone:321-350-1238
Mailing Address - Fax:321-622-8031
Practice Address - Street 1:2118 LITTLE JOHN RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3736
Practice Address - Country:US
Practice Address - Phone:321-350-1238
Practice Address - Fax:321-622-8031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-29
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care