Provider Demographics
NPI:1841693215
Name:LIFE CONNECT HEALTH LLC
Entity type:Organization
Organization Name:LIFE CONNECT HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JANA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DREYZEHNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-800-2735
Mailing Address - Street 1:415 CHURCH ST
Mailing Address - Street 2:UNIT 2802
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-1847
Mailing Address - Country:US
Mailing Address - Phone:844-800-2735
Mailing Address - Fax:844-800-2735
Practice Address - Street 1:415 CHURCH ST
Practice Address - Street 2:UNIT 2802
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37219
Practice Address - Country:US
Practice Address - Phone:276-356-5262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000293942084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945581Medicaid
TN3821648Medicaid
G70482Medicare UPIN
007703C65Medicare PIN