Provider Demographics
NPI:1912375650
Name:LIFEWAY EASE, LLC
Entity Type:Organization
Organization Name:LIFEWAY EASE, LLC
Other - Org Name:LIFEWAY MOBILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERGANTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-292-1111
Mailing Address - Street 1:40 A WESTON STREET
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06120-1538
Mailing Address - Country:US
Mailing Address - Phone:860-292-1111
Mailing Address - Fax:
Practice Address - Street 1:40 A WESTON STREET
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-1538
Practice Address - Country:US
Practice Address - Phone:860-292-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFEWAY MOBILITY HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-11
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies