Provider Demographics
NPI:1982256129
Name:LIFEWORX
Entity Type:Organization
Organization Name:LIFEWORX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-586-2467
Mailing Address - Street 1:5954 BROADWAY BLVD # 107
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-5822
Mailing Address - Country:US
Mailing Address - Phone:833-586-2467
Mailing Address - Fax:833-586-2467
Practice Address - Street 1:6001 LAKE HUBBARD PKWY
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-4727
Practice Address - Country:US
Practice Address - Phone:833-586-2467
Practice Address - Fax:833-586-2467
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUNA UNLIMITED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty