# A SUNCOAST LIFE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** A Suncoast Life, Inc.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306436159
- **Authorized official:** JOHNATHAN ERIC FOURTHMAN (PRESIDENT/OWNER)
- **Authorized official phone:** (239) 888-3111

## Contact information

- **Practice address:** 1100 E BAY DR \# G-78, LARGO, FL 33770-2541
- **Practice address phone:** (239) 888-3111
- **Mailing address:** 1100 E BAY DR \# G-78, LARGO, FL 33770-2541
- **Mailing address phone:** (239) 888-3111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171M00000X | Case Manager/Care Coordinator | — | — | Yes |

## Other

- **Enumeration date:** 01/25/2021
- **Last updated:** 01/25/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1689090979 | — | FL |