Provider Demographics
NPI:1568864734
Name:LIFE & HEALTH SERVICES
Entity Type:Organization
Organization Name:LIFE & HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:T
Authorized Official - Last Name:POORE
Authorized Official - Suffix:
Authorized Official - Credentials:OM
Authorized Official - Phone:606-242-2519
Mailing Address - Street 1:1814 CUMBERLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965
Mailing Address - Country:US
Mailing Address - Phone:606-242-2519
Mailing Address - Fax:606-242-2520
Practice Address - Street 1:1814 CUMBERLAND AVENUE
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965
Practice Address - Country:US
Practice Address - Phone:606-242-2519
Practice Address - Fax:606-242-2520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY800179103TC0700X
KY40049261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty