Provider Demographics
NPI:1215309265
Name:LIFE AND LEISURE PLUS
Entity type:Organization
Organization Name:LIFE AND LEISURE PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-599-4620
Mailing Address - Street 1:6320 MIRAMAR PKWY
Mailing Address - Street 2:STE F
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3999
Mailing Address - Country:US
Mailing Address - Phone:954-599-4620
Mailing Address - Fax:
Practice Address - Street 1:6320 MIRAMAR PKWY
Practice Address - Street 2:STE F
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-3999
Practice Address - Country:US
Practice Address - Phone:954-599-4620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Single Specialty