Organization
A SUNCOAST LIFE, INC.
Active
Other names
A Suncoast Life, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNATHAN ERIC FOURTHMAN (PRESIDENT/OWNER)
(239) 888-3111
Entity
Organization
Contact information
Practice address
1100 E BAY DR # G-78, LARGO, FL 33770-2541
(239) 888-3111
Mailing address
1100 E BAY DR # G-78, LARGO, FL 33770-2541
(239) 888-3111
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689090979
—
FL
Enumeration date
01/25/2021
Last updated
01/25/2021
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