Provider Demographics
NPI:1609406297
Name:SEEDS 4 LIFE INC
Entity Type:Organization
Organization Name:SEEDS 4 LIFE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:CMS,QMHS
Authorized Official - Phone:937-949-7095
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-0007
Mailing Address - Country:US
Mailing Address - Phone:937-949-7095
Mailing Address - Fax:
Practice Address - Street 1:4812 FREDERICK PIKE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-3835
Practice Address - Country:US
Practice Address - Phone:937-949-7095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management