NPI:
1437773280
Provider Name:
LIVE LOVE LIFE, INC
Doing Business As: LIVE LOVE LIFE, SOUTHSIDE JACKSONVILLE
Classification:
Clinic/Center - 261QC1500X
Entity Type:
Organization
Specialization: Community Health
CLIA Number: 10D2193589
Address:
1702 RIDGEWOOD AVE STE J
HOLLY HILL, FL
ZIP 32117
Phone:
(904) 458-5444
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LIVE LOVE LIFE, INC is a community health clinic center in Holly Hill, FL. LIVE LOVE LIFE, INC NPI is 1437773280. The provider is registered as an organization entity type.
The provider Is Doing Business As Live Love Life, Southside Jacksonville.
The provider's business location address is:
1702 RIDGEWOOD AVE STE J
HOLLY HILL, FL
ZIP 32117-783
Phone: (904) 458-5444
Fax: (386) 760-7649
The provider's authorized official is Mark A. Walczyk .
The authorized official title is Chief Operating Officer and has the following contact phone number (585) 233-0105.
The CLIA number assigned to this NPI record is 10D2193589 - mobile laboratory with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 6/7/2020 and was last updated on 4/25/2024.