Provider Demographics
NPI:1184311813
Name:HEALTHY LIFE GOURMET LLC
Entity type:Organization
Organization Name:HEALTHY LIFE GOURMET LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LIANET
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-829-9209
Mailing Address - Street 1:22708 SW 94TH PATH
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1266
Mailing Address - Country:US
Mailing Address - Phone:178-682-9920
Mailing Address - Fax:
Practice Address - Street 1:126 SE 37TH PL # 126
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-6216
Practice Address - Country:US
Practice Address - Phone:786-829-9209
Practice Address - Fax:305-230-7546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals