Provider Demographics
NPI:1457547739
Name:LIFE FOUNDATION
Entity Type:Organization
Organization Name:LIFE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GROESBECK
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:808-521-2437
Mailing Address - Street 1:677 ALA MOANA BLVD STE 226
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5416
Mailing Address - Country:US
Mailing Address - Phone:808-521-2437
Mailing Address - Fax:808-521-1279
Practice Address - Street 1:677 ALA MOANA BLVD STE 226
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5416
Practice Address - Country:US
Practice Address - Phone:808-521-2437
Practice Address - Fax:808-521-1279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management