Healthcare Provider Details

I. General information

NPI: 1689299372
Provider Name (Legal Business Name): LIFE CONTINUES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 W 5TH ST
PORTAGEVILLE MO
63873-1108
US

IV. Provider business mailing address

412 W 5TH ST
PORTAGEVILLE MO
63873-1108
US

V. Phone/Fax

Practice location:
  • Phone: 323-854-8587
  • Fax:
Mailing address:
  • Phone: 323-854-8587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ROBERT MILLER
Title or Position: PROVIDER
Credential:
Phone: 203-828-8931