Provider Demographics
NPI:1770327454
Name:LIFE BALANCE SUPPORT SERVICES INC
Entity type:Organization
Organization Name:LIFE BALANCE SUPPORT SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MONTES SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-366-9888
Mailing Address - Street 1:2131 HOLLYWOOD BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6775
Mailing Address - Country:US
Mailing Address - Phone:954-366-9888
Mailing Address - Fax:305-422-9029
Practice Address - Street 1:2131 HOLLYWOOD BLVD STE 401
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6775
Practice Address - Country:US
Practice Address - Phone:786-208-9094
Practice Address - Fax:305-422-9029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-19
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health