| Enhanced Lifestyle Senior Healthcare Llc | |
|
2125 Harden Blvd Lakeland FL 33803-5918 | |
| (863) 222-4060 | |
| Not Available |
| Full Name | Enhanced Lifestyle Senior Healthcare Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2125 Harden Blvd, Lakeland, Florida |
| Authorized Official Name and Position | David Gonzalez (OWNER) |
| Authorized Official Contact | 8134536179 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Enhanced Lifestyle Senior Healthcare Llc 2125 Harden Blvd Lakeland FL 33803-5918 Ph: () - | Enhanced Lifestyle Senior Healthcare Llc 2125 Harden Blvd Lakeland FL 33803-5918 Ph: (863) 222-4060 |
| NPI Number | 1902558406 |
|---|---|
| Provider Enumeration Date | 01/25/2022 |
| Last Update Date | 05/06/2022 |
| Certification Date | 05/06/2022 |
| Medicare PECOS PAC ID | 5890175673 |
|---|---|
| Medicare Enrollment ID | O20220711002700 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902558406 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Mario Jorge Gonzalez Fernandez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427479310 PECOS PAC ID: 5597055657 Enrollment ID: I20160601001388 |
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