Provider Demographics
NPI:1336925106
Name:STRATUM LIFE, LLC
Entity type:Organization
Organization Name:STRATUM LIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SAIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUHAMID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-552-7500
Mailing Address - Street 1:6310 CAPITAL DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4144 20TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-5001
Practice Address - Country:US
Practice Address - Phone:941-248-1550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-06
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No302R00000XManaged Care OrganizationsHealth Maintenance Organization