Provider Demographics
NPI:1780964429
Name:LIFEWORX INC
Entity type:Organization
Organization Name:LIFEWORX INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MERILEE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS SPEC ED
Authorized Official - Phone:785-215-6648
Mailing Address - Street 1:5740 SW WOODBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-2392
Mailing Address - Country:US
Mailing Address - Phone:785-215-6648
Mailing Address - Fax:785-783-7466
Practice Address - Street 1:5740 SW WOODBRIDGE DR
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2392
Practice Address - Country:US
Practice Address - Phone:785-215-6648
Practice Address - Fax:785-783-7466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200750420AMedicaid