Organization
LIVE LOVE LIFE, INC
Active
Other names
Live Love Life, Daytona, Live Love Life, Jacksonville, Live Love Life, DeLand, Live Love Life, Ormond, Live Love Life Orlando, Live Love Life, Universal Orlando, Live Love Life, Southside Jacksonville, LIVE LOVE LIFE, HOLLY HILL
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK A. WALCZYK (CHIEF OPERATING OFFICER)
(585) 233-0105
Entity
Organization
Contact information
Practice address
1702 RIDGEWOOD AVE STE J, HOLLY HILL, FL 32117-1783
(904) 458-5444
(386) 760-7649
Mailing address
1700 RIDGEWOOD AVE STE I, HOLLY HILL, FL 32117-1782
(904) 458-5444
(386) 760-7649
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251V00000X
Voluntary or Charitable Agency
—
—
261QC1500X
Community Health Clinic/Center
Primary
—
—
261QP0905X
State or Local Public Health Clinic/Center
—
—
Other
Enumeration date
06/07/2020
Last updated
04/25/2024
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