| Organization Name: | EXTENDED LIFE PAIN & WELLNESS CENTER |
| NPI Number: | 1487932059 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CAROL SIMS (OWNER) |
| Mailing Address: | 1418 S Federal Hwy Dania Beach |
| State: | FL US |
| Postal Code: | 330044349 |
| Phone Number: | 9549219555 |
| Fax Number: | |
| NPI Enumeration Date: | 07/29/2011 |
| NPI Last Update Date: | 07/29/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP3300X |
| License Number: | HCC 8950 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Pain |
| Taxonomy Definition: | |