Provider Demographics
NPI:1083815104
Name:LIFE UNLIMITED, INC.
Entity Type:Organization
Organization Name:LIFE UNLIMITED, INC.
Other - Org Name:UCP OF GREATER KANSAS CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P. OF UNLIMITED PROPERTY MANAGEME
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:DEGASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-781-4332
Mailing Address - Street 1:320 ARMOUR RD
Mailing Address - Street 2:
Mailing Address - City:N KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3515
Mailing Address - Country:US
Mailing Address - Phone:816-474-3026
Mailing Address - Fax:816-474-3029
Practice Address - Street 1:11201 WORNALL TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-5347
Practice Address - Country:US
Practice Address - Phone:816-474-3026
Practice Address - Fax:816-474-3029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO171M00000X
320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO856273206Medicaid