Provider Demographics
NPI:1275257487
Name:TOTAL LIFE CENTER OF SOUTHSIDE VIRGINIA
Entity Type:Organization
Organization Name:TOTAL LIFE CENTER OF SOUTHSIDE VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:MOORE
Authorized Official - Last Name:OAKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-321-3569
Mailing Address - Street 1:5963 NAMOZINE RD
Mailing Address - Street 2:
Mailing Address - City:CREWE
Mailing Address - State:VA
Mailing Address - Zip Code:23930-2734
Mailing Address - Country:US
Mailing Address - Phone:817-879-1048
Mailing Address - Fax:
Practice Address - Street 1:5963 NAMOZINE RD
Practice Address - Street 2:
Practice Address - City:CREWE
Practice Address - State:VA
Practice Address - Zip Code:23930-2734
Practice Address - Country:US
Practice Address - Phone:817-879-1048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty