Provider Demographics
NPI:1104417476
Name:HEALTHY LIFE COMMUNITY CENTER
Entity type:Organization
Organization Name:HEALTHY LIFE COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BELKIS
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:HERNANDEZ SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-532-3632
Mailing Address - Street 1:5881 NW 151ST ST STE 206
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2456
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5881 NW 151ST ST STE 206
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2456
Practice Address - Country:US
Practice Address - Phone:786-532-3632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)