Provider Demographics
NPI:1720770480
Name:SKILLS FOR LIFE LLC
Entity Type:Organization
Organization Name:SKILLS FOR LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-742-3028
Mailing Address - Street 1:7149 SW 103RD COURT CIR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1331
Mailing Address - Country:US
Mailing Address - Phone:305-742-3028
Mailing Address - Fax:
Practice Address - Street 1:7149 SW 103RD COURT CIR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1331
Practice Address - Country:US
Practice Address - Phone:305-742-3028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1760568737Medicaid