Provider Demographics
NPI:1225876014
Name:FIRST LINE HEALTH
Entity type:Organization
Organization Name:FIRST LINE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:C
Authorized Official - Last Name:PAIGE
Authorized Official - Suffix:
Authorized Official - Credentials:PM
Authorized Official - Phone:407-221-6398
Mailing Address - Street 1:3008 ZANDER DR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32735-9020
Mailing Address - Country:US
Mailing Address - Phone:407-221-6398
Mailing Address - Fax:
Practice Address - Street 1:3008 ZANDER DR
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32735-9020
Practice Address - Country:US
Practice Address - Phone:407-221-6398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty