Provider Demographics
NPI:1306115076
Name:IDEAL LIFE US INC.
Entity type:Organization
Organization Name:IDEAL LIFE US INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:GIOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-433-2541
Mailing Address - Street 1:2110 N OCEAN BLVD STE 12D
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1947
Mailing Address - Country:US
Mailing Address - Phone:888-433-2541
Mailing Address - Fax:416-489-3009
Practice Address - Street 1:2110 N OCEAN BLVD STE 12D
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33305-1947
Practice Address - Country:US
Practice Address - Phone:888-433-2541
Practice Address - Fax:416-489-3009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies