Healthcare Provider Details

I. General information

NPI: 1073270963
Provider Name (Legal Business Name): LIFE TOWN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2021
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3970 LARDNER LANE
COLORADO SPRINGS CO
80916-8091
US

IV. Provider business mailing address

3970 LARDNER LN
COLORADO SPRINGS CO
80916-2823
US

V. Phone/Fax

Practice location:
  • Phone: 719-299-6487
  • Fax:
Mailing address:
  • Phone: 719-200-6487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MS. CONNIE BROOKS
Title or Position: CEO
Credential:
Phone: 719-200-6487