# PROVIDENCE FAMILY LIFE CENTER CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326773045
- **Authorized official:** LAURA KOHLER (BILLING SPECIALIST)
- **Authorized official phone:** (813) 720-7694

## Contact information

- **Practice address:** 3592 BROADWAY STE 100, FORT MYERS, FL 33901-8056
- **Practice address phone:** (239) 676-3159
- **Practice address fax:** (239) 519-9202
- **Mailing address:** 3049 CLEVELAND AVE, FORT MYERS, FL 33901-7041
- **Mailing address phone:** (239) 676-3159
- **Mailing address fax:** (888) 519-9202

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/18/2022
- **Last updated:** 07/18/2022