Basic Information
| Provider Information | |||||||||
| NPI: | 1801471503 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIFE RESOURCES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 950 PENINSULA CORPORATE CIR STE 2000 | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334871386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612346599 | ||||||||
| FaxNumber: | 8662404606 | ||||||||
| Practice Location | |||||||||
| Address1: | 1447 MEDICAL PARK BLVD STE 205 | ||||||||
| Address2: | |||||||||
| City: | WELLINGTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334143164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612346599 | ||||||||
| FaxNumber: | 8662404606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2021 | ||||||||
| LastUpdateDate: | 03/14/2021 | ||||||||
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| AuthorizedOfficialLastName: | ARENSTEIN | ||||||||
| AuthorizedOfficialFirstName: | JON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5612346599 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 03/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.