| Life Community Wellness Center Corp | |
|
2328 10th Ave N Ste 106 Lake Worth FL 33461-6612 | |
| (561) 676-1690 | |
| Not Available |
| Full Name | Life Community Wellness Center Corp |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2328 10th Ave N Ste 106, Lake Worth, Florida |
| Authorized Official Name and Position | Maira Crespo (PRESIDENT) |
| Authorized Official Contact | 5616761690 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Community Wellness Center Corp 2328 10th Ave N Ste 106 Lake Worth FL 33461-6612 Ph: (561) 676-1690 | Life Community Wellness Center Corp 2328 10th Ave N Ste 106 Lake Worth FL 33461-6612 Ph: (561) 676-1690 |
| NPI Number | 1851981591 |
|---|---|
| Provider Enumeration Date | 01/26/2021 |
| Last Update Date | 01/26/2021 |
| Certification Date | 01/26/2021 |
| Medicare PECOS PAC ID | 4385009554 |
|---|---|
| Medicare Enrollment ID | O20230424002108 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851981591 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Roy C Musoff |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104820745 PECOS PAC ID: 5799743399 Enrollment ID: I20041229000629 |
| Provider Name | Mayelin Morales |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790220911 PECOS PAC ID: 4688067648 Enrollment ID: I20220215002658 |
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