Provider Demographics
NPI:1013039833
Name:LIFETIME RESOURCES, INC.
Entity Type:Organization
Organization Name:LIFETIME RESOURCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-432-6202
Mailing Address - Street 1:13091 BENEDICT DR
Mailing Address - Street 2:
Mailing Address - City:DILLSBORO
Mailing Address - State:IN
Mailing Address - Zip Code:47018-8480
Mailing Address - Country:US
Mailing Address - Phone:812-432-6202
Mailing Address - Fax:
Practice Address - Street 1:13091 BENEDICT DR
Practice Address - Street 2:
Practice Address - City:DILLSBORO
Practice Address - State:IN
Practice Address - Zip Code:47018-8480
Practice Address - Country:US
Practice Address - Phone:812-432-6202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
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IN200224930AMedicaid
IN200858720AMedicaid
IN200835640AMedicaid
IN200881090AMedicaid
IN100101800AMedicaid
IN200187920AMedicaid
IN200187910AMedicaid