Provider Demographics
NPI:1932887825
Name:LYFE RECOVERY CENTER LLC
Entity Type:Organization
Organization Name:LYFE RECOVERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JC
Authorized Official - Middle Name:
Authorized Official - Last Name:KANYEMERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-777-9288
Mailing Address - Street 1:7025 E 21ST ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-4733
Mailing Address - Country:US
Mailing Address - Phone:520-404-7379
Mailing Address - Fax:
Practice Address - Street 1:7025 E 21ST ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-4733
Practice Address - Country:US
Practice Address - Phone:520-404-7379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health