Organization
LIFE MANAGEMENT OF NW FL, INC.
Active
Parent organization
LIFE MANAGEMENT CENTER OF NORTHWEST FLORIDA, INC.
Other names
Life Management Center of Northwest Florida Inc
Organization subpart
Yes
Provider details
NPI number
Legal business name
LIFE MANAGEMENT CENTER OF NORTHWEST FLORIDA, INC.
Authorized official
EDWIN AILES (CEO/PRESIDENT)
(850) 522-4485
Entity
Organization
Contact information
Practice address
311 WILLIAMS AVE, PORT ST JOE, FL 32456-1845
(850) 522-4480
(850) 914-6281
Mailing address
525 E 15TH ST, PANAMA CITY, FL 32405-5412
(850) 522-4480
(850) 914-6281
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060296530
—
FL
Enumeration date
07/04/2006
Last updated
04/24/2025
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