Provider Demographics
NPI:1649248733
Name:LIFE LONG LEARNING CENTER, INC
Entity type:Organization
Organization Name:LIFE LONG LEARNING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESPIRATORY THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:SWIHART
Authorized Official - Suffix:
Authorized Official - Credentials:CRTT
Authorized Official - Phone:772-340-0594
Mailing Address - Street 1:1699 SW SOUTHWORTH TER
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-1012
Mailing Address - Country:US
Mailing Address - Phone:772-340-0594
Mailing Address - Fax:772-340-0594
Practice Address - Street 1:1699 SW SOUTHWORTH TER
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-1012
Practice Address - Country:US
Practice Address - Phone:772-340-0594
Practice Address - Fax:772-304-0594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL385H00000X, 347C00000X, 2278C0205X, 227800000X, 2278E0002X
177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Not Answered347C00000XTransportation ServicesPrivate VehicleGroup - Multi-Specialty
Not Answered177F00000XOther Service ProvidersLodgingGroup - Multi-Specialty
Not Answered2278C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedCritical CareGroup - Multi-Specialty
Not Answered227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGroup - Multi-Specialty
Not Answered2278E0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedEmergency CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLTUC228OtherRESPIRATORY