Provider Demographics
NPI:1598539975
Name:LIFE SOURCE SERVICES, LLC
Entity Type:Organization
Organization Name:LIFE SOURCE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT ASI MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:H
Authorized Official - Last Name:PARKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-709-1408
Mailing Address - Street 1:359 TOWNE CENTER BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4862
Mailing Address - Country:US
Mailing Address - Phone:601-991-3840
Mailing Address - Fax:
Practice Address - Street 1:359 TOWNE CENTER BLVD STE 500
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4862
Practice Address - Country:US
Practice Address - Phone:601-991-3840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFE SOURCE SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based