Healthcare Provider Details

I. General information

NPI: 1003237058
Provider Name (Legal Business Name): LIFE MAGNIFIED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8203 LICHTENAUER DR
LENEXA KS
66219-1637
US

IV. Provider business mailing address

8203 LICHTENAUER DR
LENEXA KS
66219-1637
US

V. Phone/Fax

Practice location:
  • Phone: 913-859-9707
  • Fax:
Mailing address:
  • Phone: 913-859-9707
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateKS

VIII. Authorized Official

Name: MS. GERALDINE A HELLER-COOK
Title or Position: DIRECTOR
Credential:
Phone: 913-859-9707