Provider Demographics
NPI:1003237058
Name:LIFE MAGNIFIED
Entity Type:Organization
Organization Name:LIFE MAGNIFIED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HELLER-COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-859-9707
Mailing Address - Street 1:8203 LICHTENAUER DR
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-1637
Mailing Address - Country:US
Mailing Address - Phone:913-859-9707
Mailing Address - Fax:
Practice Address - Street 1:8203 LICHTENAUER DR
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-1637
Practice Address - Country:US
Practice Address - Phone:913-859-9707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
KS253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care