Provider Demographics
NPI:1982972360
Name:LIFE TO LIFE
Entity Type:Organization
Organization Name:LIFE TO LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMPHRIE
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:414-304-4883
Mailing Address - Street 1:1109 N MAYFAIR RD STE 202
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3430
Mailing Address - Country:US
Mailing Address - Phone:414-304-4883
Mailing Address - Fax:414-231-9899
Practice Address - Street 1:1109 N MAYFAIR RD STE 202
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3430
Practice Address - Country:US
Practice Address - Phone:414-304-4883
Practice Address - Fax:414-231-9899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251300000XAgenciesLocal Education Agency (LEA)
No251G00000XAgenciesHospice Care, Community Based
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care