Provider Demographics
NPI:1558719864
Name:LIFE LINKS
Entity Type:Organization
Organization Name:LIFE LINKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMIQUIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-616-4225
Mailing Address - Street 1:928 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PAMPLICO
Mailing Address - State:SC
Mailing Address - Zip Code:29583-6810
Mailing Address - Country:US
Mailing Address - Phone:843-616-4225
Mailing Address - Fax:
Practice Address - Street 1:928 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:PAMPLICO
Practice Address - State:SC
Practice Address - Zip Code:29583-6810
Practice Address - Country:US
Practice Address - Phone:843-616-4225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health