Provider Demographics
NPI:1568767598
Name:LIFE RESOURCES, INC.
Entity Type:Organization
Organization Name:LIFE RESOURCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:505-250-8552
Mailing Address - Street 1:PO BOX 92321
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87199-2321
Mailing Address - Country:US
Mailing Address - Phone:505-250-8552
Mailing Address - Fax:505-814-5740
Practice Address - Street 1:4801 LANG AVE NE STE 110
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4475
Practice Address - Country:US
Practice Address - Phone:505-463-0507
Practice Address - Fax:505-814-5740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-23
Last Update Date:2011-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM03-204201-00-9251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health