Healthcare Provider Details

I. General information

NPI: 1114529427
Provider Name (Legal Business Name): LIFE4MAT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8959 COLORADO BLVD APT 104
THORNTON CO
80229-4094
US

IV. Provider business mailing address

8959 COLORADO BLVD APT 104
THORNTON CO
80229-4094
US

V. Phone/Fax

Practice location:
  • Phone: 720-427-7363
  • Fax:
Mailing address:
  • Phone: 720-427-7363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: LINDA THOMAS-WARE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 720-427-7363