Provider Demographics
NPI:1255904678
Name:LIFE LAUNCH CENTERS, LLC
Entity type:Organization
Organization Name:LIFE LAUNCH CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JONI
Authorized Official - Middle Name:
Authorized Official - Last Name:DYCHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-803-8240
Mailing Address - Street 1:230 N 1680 E STE J1
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-2588
Mailing Address - Country:US
Mailing Address - Phone:435-767-0552
Mailing Address - Fax:435-767-0278
Practice Address - Street 1:52 S 850 W STE 202B
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-3361
Practice Address - Country:US
Practice Address - Phone:435-862-3452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFE LAUNCH CENTERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty