Healthcare Provider Details

I. General information

NPI: 1417183906
Provider Name (Legal Business Name): LIFEWAYS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 WILLAMETTE ST
UMATILLA OR
97882-6601
US

IV. Provider business mailing address

702 SUNSET DR
ONTARIO OR
97914-3121
US

V. Phone/Fax

Practice location:
  • Phone: 541-889-9167
  • Fax: 541-889-7873
Mailing address:
  • Phone: 541-889-9167
  • Fax: 541-889-7873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateOR

VIII. Authorized Official

Name: JUDY A CORDENIZ
Title or Position: CEO
Credential:
Phone: 541-889-9167