A Life Foundation Family Services, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

A LIFE FOUNDATION FAMILY SERVICES, LLC

Practice address

14179 Danpark Loop
Fort Myers, FL 33912-6853

Phone

(919) 672-3939

NPI assigned

Nov 27, 2012

Last updated

Nov 27, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Carlos M Garcia Samuels, OWNERNPI 1366751042

Title

Ceo

Phone

(919) 672-3939

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Carlos Garcia-Samuels

  • Community/Behavioral Health Agency
  • Raleigh, NC
  • NPI 1366751042
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1353974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353974400000",
    "number": "1063756377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14179 DANPARK LOOP",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339126853",
            "telephone_number": "919-672-3939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14179 DANPARK LOOP",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339126853",
            "telephone_number": "919-672-3939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A LIFE FOUNDATION FAMILY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-27",
        "last_updated": "2012-11-27",
        "status": "A",
        "authorized_official_last_name": "GARCIA SAMUELS",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "919-672-3939",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OWNER"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.