Provider Demographics
NPI:1164749487
Name:THE LIFE CENTER
Entity Type:Organization
Organization Name:THE LIFE CENTER
Other - Org Name:TLC-THE LIFE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-349-1910
Mailing Address - Street 1:1440 GOODRICH DR
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3810
Mailing Address - Country:US
Mailing Address - Phone:307-349-1910
Mailing Address - Fax:
Practice Address - Street 1:1440 GOODRICH DR
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3810
Practice Address - Country:US
Practice Address - Phone:307-349-1910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management