Provider Demographics
NPI:1205377124
Name:CORLIFE LLC
Entity Type:Organization
Organization Name:CORLIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:UNDERHILL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:920-336-6362
Mailing Address - Street 1:2200 DICKINSON RD STE A
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-4056
Mailing Address - Country:US
Mailing Address - Phone:920-336-6362
Mailing Address - Fax:
Practice Address - Street 1:2200 DICKINSON RD STE A
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-4056
Practice Address - Country:US
Practice Address - Phone:920-336-6362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies