Healthcare Provider Details

I. General information

NPI: 1437076437
Provider Name (Legal Business Name): LIFE ACCESS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 GLENN OAK DR
SOUTH BEND IN
46628-6123
US

IV. Provider business mailing address

3440 GLENN OAK DR
SOUTH BEND IN
46628-6123
US

V. Phone/Fax

Practice location:
  • Phone: 574-340-5941
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY SMALLWOOD
Title or Position: OWNER
Credential:
Phone: 574-340-5941