1427356617 NPI number — ABSOLUTE BALANCE OF LIFE HEALTH AND WELLNESS CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427356617 NPI number — ABSOLUTE BALANCE OF LIFE HEALTH AND WELLNESS CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABSOLUTE BALANCE OF LIFE HEALTH AND WELLNESS CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427356617
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2561 NW 79TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARGATE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33063-8156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-353-2265
Provider Business Mailing Address Fax Number:
561-353-2267

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 PLAZA REAL S
Provider Second Line Business Practice Location Address:
SUITE G.
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33432-4837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-353-2265
Provider Business Practice Location Address Fax Number:
561-353-2267
Provider Enumeration Date:
03/11/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LAZZARI
Authorized Official First Name:
BRAZELIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-353-2265

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AP2366 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: ME36889 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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