Provider Demographics
NPI:1891495263
Name:LIFE INTERVENTION TEAM
Entity Type:Organization
Organization Name:LIFE INTERVENTION TEAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-342-1062
Mailing Address - Street 1:257 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4905
Mailing Address - Country:US
Mailing Address - Phone:802-342-1062
Mailing Address - Fax:802-419-9351
Practice Address - Street 1:257 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4905
Practice Address - Country:US
Practice Address - Phone:802-342-1062
Practice Address - Fax:802-419-9351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No177F00000XOther Service ProvidersLodging
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
No347C00000XTransportation ServicesPrivate Vehicle