Provider Demographics
NPI:1932860467
Name:LIFEFORCE HEALTH INC
Entity Type:Organization
Organization Name:LIFEFORCE HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LA GRANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-465-8467
Mailing Address - Street 1:4722 N 95TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-1037
Mailing Address - Country:US
Mailing Address - Phone:602-465-8467
Mailing Address - Fax:
Practice Address - Street 1:4722 N 95TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-1037
Practice Address - Country:US
Practice Address - Phone:602-465-8467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center