MEDICARE: LIFE'S WORC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency	7075466	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053452433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE'S WORC

Provider Business Mailing Address
First Line	:	1501 FRANKLIN AVE
Second Line	:
City	:	GARDEN CITY
State	:	NY
Zip	:	11553-8165
Country	:	US
Telephone Number	:	516-741-9000
Fax Number	:	516-302-1802

Provider Business Practice Location Address
First Line	:	21939 91ST RD
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11428-1328
Country	:	US
Telephone Number	:	718-736-0397
Fax Number	:	718-736-0389

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MS. PEG BARRY
Credential	:
Telephone Number	:	516-741-9000

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	08/22/2020

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Directions to “LIFE'S WORC ” Practice Location

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