Provider Demographics
NPI:1457712820
Name:LIFE'S PRECIOUS MOMENTS
Entity Type:Organization
Organization Name:LIFE'S PRECIOUS MOMENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LENESE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:203-435-6468
Mailing Address - Street 1:503 WOLCOTT RD
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-2673
Mailing Address - Country:US
Mailing Address - Phone:203-441-4371
Mailing Address - Fax:203-441-4375
Practice Address - Street 1:503 WOLCOTT RD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-2673
Practice Address - Country:US
Practice Address - Phone:203-441-4371
Practice Address - Fax:203-441-4375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008856174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty