Organization
GIFT OF LIFE COMMUNITY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEE WAYNE SCHARRER MSW (EXECUTIVE DIRECTOR)
(727) 547-0607
Entity
Organization
Contact information
Practice address
4425 PARK BLVD, PINELLAS PARK, FL 33781-3540
(727) 547-0607
Mailing address
4425 PARK BLVD, PINELLAS PARK, FL 33781-3540
(727) 547-0607
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
281413
AMERIGROUP
FL
01
—
337877
UNITED HEALTHCARE
FL
01
—
550560
VALUE OPTIONS PMHP
FL
Enumeration date
09/29/2006
Last updated
08/22/2020
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