Healthcare Provider Details

I. General information

NPI: 1457476830
Provider Name (Legal Business Name): LIFE UNLIMITED, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 BIRMINGHAM RD
LIBERTY MO
64068-2767
US

IV. Provider business mailing address

320 ARMOUR RD STE. 101
N KANSAS CITY MO
64116-3506
US

V. Phone/Fax

Practice location:
  • Phone: 816-474-3026
  • Fax: 816-474-3029
Mailing address:
  • Phone: 816-474-3026
  • Fax: 816-474-3029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number852755800
License Number StateMO

VIII. Authorized Official

Name: SANDRA JEANNE DEGASE
Title or Position: VP UNLIMITED PROPERTY MANAGEMENT
Credential:
Phone: 816-474-3026