Provider Demographics
NPI:1851327605
Name:L.I.F.E CENTER FOR INDEPENDENT LIVING
Entity Type:Organization
Organization Name:L.I.F.E CENTER FOR INDEPENDENT LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:AZINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-756-4314
Mailing Address - Street 1:1109 STE. GENEVIEVE AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640
Mailing Address - Country:US
Mailing Address - Phone:573-756-4314
Mailing Address - Fax:573-756-3507
Practice Address - Street 1:1109 STE. GENEVIEVE AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640
Practice Address - Country:US
Practice Address - Phone:573-756-4314
Practice Address - Fax:573-756-3507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty