Provider Demographics
NPI:1538300892
Name:LIFE CONNECTION, L.C.
Entity Type:Organization
Organization Name:LIFE CONNECTION, L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:EILERS
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:515-720-6367
Mailing Address - Street 1:1953 1ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5328
Mailing Address - Country:US
Mailing Address - Phone:319-364-1953
Mailing Address - Fax:319-364-1970
Practice Address - Street 1:1953 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5328
Practice Address - Country:US
Practice Address - Phone:319-364-1953
Practice Address - Fax:319-364-1970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2022-06-02
Deactivation Date:2022-03-28
Deactivation Code:
Reactivation Date:2022-06-02
Provider Licenses
StateLicense IDTaxonomies
IA06248104100000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty