Provider Demographics
NPI:1780479824
Name:FIT FOR LIFE
Entity type:Organization
Organization Name:FIT FOR LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:BRASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-780-2306
Mailing Address - Street 1:6 GAME LN
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3412
Mailing Address - Country:US
Mailing Address - Phone:516-780-2306
Mailing Address - Fax:
Practice Address - Street 1:6 GAME LN
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3412
Practice Address - Country:US
Practice Address - Phone:516-780-2306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHYER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health