Healthcare Provider Details

I. General information

NPI: 1174777064
Provider Name (Legal Business Name): LIFELONG INDEPENDENCE AND FITNESS ENRICHMENT CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 GALLAGHER DR
SHERMAN TX
75090-1713
US

IV. Provider business mailing address

1111 GALLAGHER DR
SHERMAN TX
75090-1713
US

V. Phone/Fax

Practice location:
  • Phone: 903-870-7000
  • Fax: 903-870-7188
Mailing address:
  • Phone: 903-870-7000
  • Fax: 903-870-7188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. JANIS G THOMPSON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 903-870-7117