1013039833 NPI number — LIFETIME RESOURCES, INC.

Table of content: (NPI 1013039833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013039833 NPI number — LIFETIME RESOURCES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFETIME RESOURCES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013039833
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13091 BENEDICT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DILLSBORO
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47018-8480
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-432-6202
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13091 BENEDICT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DILLSBORO
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47018-8480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-432-6202
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BECKLEY
Authorized Official First Name:
SALLY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
812-432-6202

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200381370A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200878120A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100324410A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200345140A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100265190A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200878110A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200224930A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200858720A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200835640A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200881090A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100101800A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200187920A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200187910A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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