MEDICARE: LIFE IN COLOR LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	261QD1600X	Developmental Disabilities Clinic/Center
3	261QP0905X	State or Local Public Health Clinic/Center
4	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1073364931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE IN COLOR LLC

Provider Business Mailing Address
First Line	:	300 CRIPPLE CREEK CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-7619
Country	:	US
Telephone Number	:	757-645-7791
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 CRIPPLE CREEK CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-7619
Country	:	US
Telephone Number	:	757-645-7791
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOSEPHENA WINFIELD
Credential	:
Telephone Number	:	757-994-3053

Provider Enumeration Date	:	03/28/2024
Last Update Date	:	04/03/2024

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Directions to “LIFE IN COLOR LLC ” Practice Location

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