NPIMap

Organization Active NPI

Live Love Life, Inc

Doing business as Live Love Life, Holly Hill

  • Community Health Clinic/Center
  • Holly Hill, FL
National Provider Identifier
1437773280
Registry record updated Apr 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
LIVE LOVE LIFE, INC
Doing business as
Live Love Life, Holly Hill
Live Love Life Orlando
Live Love Life, Daytona5 more in Other names
Practice address
1702 Ridgewood Ave Ste J
Holly Hill, FL 32117-1783
Phone
(904) 458-5444
Fax
(386) 760-7649
NPI assigned
Jun 7, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2024

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

Authorized official

Name
Mr. Mark A. Walczyk
Title
Chief Operating Officer
Phone
(585) 233-0105

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Voluntary or Charitable Agency 251V00000X
Community Health Clinic/Center 261QC1500X Primary
State or Local Public Health Clinic/Center 261QP0905X

Addresses

Primary practice location

1702 Ridgewood Ave Ste J
Holly Hill, FL 32117-1783

Mailing address

1700 Ridgewood Ave Ste I
Holly Hill, FL 32117-1782
Phone (904) 458-5444

Other practice location 1

1951 Boulevard
Jacksonville, FL 32206
Phone (904) 640-7953

Other practice location 2

6735 Conroy Rd
Ste 231
Orlando, FL 32835
Phone (407) 930-9969

Other practice location 3

5000 W Colonial Dr
Ste 110
Orlando, FL 32808
Phone (407) 847-4829

Other practice location 4

228 S Woodland Blvd
Deland, FL 32720-5414
Phone (386) 348-5242

Other practice location 5

1445 Dunn Ave Ste B
Daytona Beach, FL 32114-1437
Phone (386) 675-1030

Other practice location 6

565 Memorial Cir
Ste A-B
Ormond Beach, FL 32174-5001
Phone (386) 866-9099

Other practice location 7

6852 Belfort Oaks Place
Jacksonville, FL 32216
Phone (904) 640-7954

Other names 8

  • LIVE LOVE LIFE, HOLLY HILL Doing business as
  • Live Love Life Orlando Doing business as
  • Live Love Life, Daytona Doing business as
  • Live Love Life, DeLand Doing business as
  • Live Love Life, Jacksonville Doing business as
  • Live Love Life, Ormond Doing business as
  • Live Love Life, Southside Jacksonville Doing business as
  • Live Love Life, Universal Orlando Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2193589Live Love Life Inc1702 Ridgewood Ave - Ste J, Holly Hill, FL 32117Certificate of waiverSep 22, 2026
10D2307652Live Love Life, Inc1702 Ridgewood Ave Suite J, Holly Hill, FL 32117Certificate of waiverJul 11, 2028

National Provider Directory

National Provider Directory
Tax ID family
Live Love Life Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

228 S Woodland Blvd
Deland, FL 32720
Phone (386) 348-5242

1702 Ridgewood Ave
Ste J
Holly Hill, FL 32117
Phone (904) 458-5444

6852 Belfort Oaks Pl
Jacksonville, FL 32216
Phone (904) 296-2441

565 Memorial Cir
Ste Ab
Ormond Beach, FL 32174
Phone (386) 866-9099

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1591488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714003200000",
    "number": "1437773280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 RIDGEWOOD AVE STE I",
            "city": "HOLLY HILL",
            "state": "FL",
            "postal_code": "321171782",
            "telephone_number": "904-458-5444",
            "fax_number": "386-760-7649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1702 RIDGEWOOD AVE STE J",
            "city": "HOLLY HILL",
            "state": "FL",
            "postal_code": "321171783",
            "telephone_number": "904-458-5444",
            "fax_number": "386-760-7649"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1951 Boulevard",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "32206",
            "country_code": "US",
            "telephone_number": "904-640-7953",
            "fax_number": "386-272-7938",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6735 Conroy Rd",
            "address_2": "STE 231",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "32835",
            "country_code": "US",
            "telephone_number": "407-930-9969",
            "fax_number": "386-272-7938",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5000 W Colonial Dr",
            "address_2": "STE 110",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "32808",
            "country_code": "US",
            "telephone_number": "407-847-4829",
            "fax_number": "386-272-7938",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "228 S Woodland Blvd",
            "address_purpose": "LOCATION",
            "city": "Deland",
            "state": "FL",
            "postal_code": "327205414",
            "country_code": "US",
            "telephone_number": "386-348-5242",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1445 Dunn Ave Ste B",
            "address_purpose": "LOCATION",
            "city": "Daytona Beach",
            "state": "FL",
            "postal_code": "321141437",
            "country_code": "US",
            "telephone_number": "386-675-1030",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "565 Memorial Cir",
            "address_2": "Ste A-B",
            "address_purpose": "LOCATION",
            "city": "Ormond Beach",
            "state": "FL",
            "postal_code": "321745001",
            "country_code": "US",
            "telephone_number": "386-866-9099",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6852 Belfort Oaks Place",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "32216",
            "country_code": "US",
            "telephone_number": "904-640-7954",
            "fax_number": "386-272-7938",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIVE LOVE LIFE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-07",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-25",
        "status": "A",
        "authorized_official_last_name": "WALCZYK",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "585-233-0105",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP0905X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, State or Local",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LIVE LOVE LIFE, HOLLY HILL",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Live Love Life Orlando",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Live Love Life, Daytona",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Live Love Life, DeLand",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Live Love Life, Jacksonville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Live Love Life, Ormond",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Live Love Life, Southside Jacksonville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Live Love Life, Universal Orlando",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Holly Hill, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.