Healthcare Provider Details

I. General information

NPI: 1386436558
Provider Name (Legal Business Name): FAMILY LIFE LIFTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 BLUE HILLS AVE
BLOOMFIELD CT
06002-2721
US

IV. Provider business mailing address

1151 BLUE HILLS AVE
BLOOMFIELD CT
06002-2721
US

V. Phone/Fax

Practice location:
  • Phone: 860-243-6520
  • Fax:
Mailing address:
  • Phone: 860-243-6520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. LEROY BAILEY III
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 860-243-6520