Healthcare Provider Details

I. General information

NPI: 1700922036
Provider Name (Legal Business Name): LIFE WAY SYSTEMS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3621 US HIGHWAY 31 S # A
DECATUR AL
35603-1633
US

IV. Provider business mailing address

3621 US HWY 31 S #A POST OFFICE BOX 1309
DECATUR AL
35602-1309
US

V. Phone/Fax

Practice location:
  • Phone: 256-351-1090
  • Fax: 256-308-0803
Mailing address:
  • Phone: 256-351-1090
  • Fax: 256-308-0803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number07683
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number07683
License Number StateAL

VIII. Authorized Official

Name: DR. BARNEY R MAY
Title or Position: ADMINISTRATOR
Credential: D.D.
Phone: 256-351-1090