Organization Name: | INDEPENDENT LIFE LLC |
NPI Number: | 1023208972 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PRINCE E. GREEN (AUTHORIZED.REPRESENTATIVE) |
Mailing Address: | 4047 Ockeechobee Blvd. Ste 123 West Palm Beach |
State: | FL US |
Postal Code: | 334093236 |
Phone Number: | 5613850868 |
Fax Number: | |
NPI Enumeration Date: | 07/26/2007 |
NPI Last Update Date: | 01/02/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0401X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
Taxonomy Definition: |