Provider Demographics
NPI:1649887373
Name:LIFECRAFT LLC
Entity type:Organization
Organization Name:LIFECRAFT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:PUTNAM
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED INSTRUCTOR
Authorized Official - Phone:269-612-7222
Mailing Address - Street 1:19246 THREE OAKS RD
Mailing Address - Street 2:
Mailing Address - City:THREE OAKS
Mailing Address - State:MI
Mailing Address - Zip Code:49128-9511
Mailing Address - Country:US
Mailing Address - Phone:269-612-7222
Mailing Address - Fax:
Practice Address - Street 1:19246 THREE OAKS RD
Practice Address - Street 2:
Practice Address - City:THREE OAKS
Practice Address - State:MI
Practice Address - Zip Code:49128-9511
Practice Address - Country:US
Practice Address - Phone:269-612-7222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-27
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise PhysiologistGroup - Multi-Specialty
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Multi-Specialty
No226000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreational Therapist AssistantGroup - Multi-Specialty