Provider Demographics
NPI:1427441682
Name:LIFE SOLUTIONS OUTPATIENT CORPORATION
Entity type:Organization
Organization Name:LIFE SOLUTIONS OUTPATIENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-454-3376
Mailing Address - Street 1:901 NORTHPOINT PKWY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-1951
Mailing Address - Country:US
Mailing Address - Phone:954-746-8232
Mailing Address - Fax:954-746-8231
Practice Address - Street 1:901 NORTHPOINT PKWY
Practice Address - Street 2:SUITE 303
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-1951
Practice Address - Country:US
Practice Address - Phone:954-746-8232
Practice Address - Fax:954-746-8231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty