Provider Demographics
NPI:1790098879
Name:LIFE IN BALANCE, LLC
Entity Type:Organization
Organization Name:LIFE IN BALANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT CARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ONYANGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-687-9594
Mailing Address - Street 1:5838 W BRICK RD
Mailing Address - Street 2:SUITE 104-B
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628-8423
Mailing Address - Country:US
Mailing Address - Phone:574-255-8060
Mailing Address - Fax:574-255-8602
Practice Address - Street 1:5838 W BRICK RD
Practice Address - Street 2:SUITE 104-B
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-8423
Practice Address - Country:US
Practice Address - Phone:574-255-8060
Practice Address - Fax:574-255-8602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty