Healthcare Provider Details

I. General information

NPI: 1598941767
Provider Name (Legal Business Name): LIFE MATTERSI INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301B BUSINESS HH
PIEDMONT MO
63957-9597
US

IV. Provider business mailing address

301B BUSINESS HH
PIEDMONT MO
63957-9597
US

V. Phone/Fax

Practice location:
  • Phone: 573-223-2754
  • Fax:
Mailing address:
  • Phone: 573-223-2754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateMO

VIII. Authorized Official

Name: MR. JOHN CARL LUNYOU
Title or Position: SECRETARY OF CORP.
Credential:
Phone: 573-223-2754