Provider Demographics
NPI:1790937985
Name:LIFE MANAGEMENT INC.
Entity Type:Organization
Organization Name:LIFE MANAGEMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF STAFF/BOARD MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CT
Authorized Official - Last Name:BECKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:502-471-9538
Mailing Address - Street 1:1228 EAST BRECKINRIDGE STREET
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204
Mailing Address - Country:US
Mailing Address - Phone:502-471-9538
Mailing Address - Fax:502-895-8450
Practice Address - Street 1:1228 E BRECKINRIDGE ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-2037
Practice Address - Country:US
Practice Address - Phone:502-471-9538
Practice Address - Fax:502-895-8450
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILD OF THE KING MINISTRIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY810256251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health