Provider Demographics
NPI:1851845804
Name:BETTY LOUISE LIFE SERVICES LLC
Entity Type:Organization
Organization Name:BETTY LOUISE LIFE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HINCKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-272-3910
Mailing Address - Street 1:1201 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2126
Mailing Address - Country:US
Mailing Address - Phone:307-272-3910
Mailing Address - Fax:
Practice Address - Street 1:1201 E 7TH ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2126
Practice Address - Country:US
Practice Address - Phone:307-272-3910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health