| Life Management Center Of Northwest Florida Inc | |
|
310 E Byrd Ave Bonifay FL 32425-3006 | |
| (850) 522-4480 | |
| (850) 914-6281 |
| Full Name | Life Management Center Of Northwest Florida Inc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 310 E Byrd Ave, Bonifay, Florida |
| Authorized Official Name and Position | Edwin Ailes (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8505224480 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Management Center Of Northwest Florida Inc 525 E 15th St Panama City FL 32405-5412 Ph: (850) 522-4480 | Life Management Center Of Northwest Florida Inc 310 E Byrd Ave Bonifay FL 32425-3006 Ph: (850) 522-4480 |
| NPI Number | 1710912886 |
|---|---|
| Provider Enumeration Date | 07/11/2006 |
| Last Update Date | 03/29/2024 |
| Certification Date | 03/29/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710912886 | NPI | - | NPPES |
| 060296549 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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