Provider Demographics
NPI:1720578933
Name:LIMINAL LIFE SERVICES LLC
Entity Type:Organization
Organization Name:LIMINAL LIFE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTEYNE-CRESCIONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-369-5250
Mailing Address - Street 1:2915 RAINIER AVE S APT 209
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-6042
Mailing Address - Country:US
Mailing Address - Phone:206-369-5250
Mailing Address - Fax:
Practice Address - Street 1:2915 RAINIER AVE S APT 209
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144
Practice Address - Country:US
Practice Address - Phone:206-369-5250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty