Provider Demographics
NPI:1154669240
Name:LIFE LINE RESOURCES
Entity Type:Organization
Organization Name:LIFE LINE RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:I
Authorized Official - Last Name:LARSON SPAGON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-265-6796
Mailing Address - Street 1:2023 SANDPOINT WEST DR
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-7304
Mailing Address - Country:US
Mailing Address - Phone:208-265-6796
Mailing Address - Fax:208-255-5269
Practice Address - Street 1:2023 SANDPOINT WEST DR
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-7304
Practice Address - Country:US
Practice Address - Phone:208-265-6796
Practice Address - Fax:208-255-5269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)