Provider Demographics
NPI:1528506458
Name:COMPREHENSIVE LIFE SOUTIONS
Entity type:Organization
Organization Name:COMPREHENSIVE LIFE SOUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAIDYS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROQUE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:954-637-3167
Mailing Address - Street 1:4040 SW 84TH TER
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-2951
Mailing Address - Country:US
Mailing Address - Phone:954-637-3167
Mailing Address - Fax:
Practice Address - Street 1:4040 SW 84TH TER
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2951
Practice Address - Country:US
Practice Address - Phone:954-637-3167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-11
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health