Provider Demographics
NPI:1073364931
Name:LIFE IN COLOR LLC
Entity Type:Organization
Organization Name:LIFE IN COLOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHENA
Authorized Official - Middle Name:
Authorized Official - Last Name:WINFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-994-3053
Mailing Address - Street 1:300 CRIPPLE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7619
Mailing Address - Country:US
Mailing Address - Phone:757-645-7791
Mailing Address - Fax:
Practice Address - Street 1:300 CRIPPLE CREEK CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7619
Practice Address - Country:US
Practice Address - Phone:757-645-7791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251B00000XAgenciesCase Management
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local