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General NPI Number Information
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NPI Number | 1083683932
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Entity Type | Organization
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Legal Business Name | LIFELONG HEALTH CENTER, INC.
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 12/07/2007
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Provider Practice Location Address
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Address Line | 642 N MAIN ST
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City | SALEM
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State | AR
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Zip | 72576-0220
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Country | US
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Telephone | 870-895-5433
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Fax | 870-895-5430
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Provider Business Mailing Address
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Address Line | PO BOX 220
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City | SALEM
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State | AR
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Zip | 72576-0220
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Country | US
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Telephone | 870-895-5433
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Fax | 870-895-5430
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | MRS. LAURA ELIZABETH ESTES
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Credential |
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Telephone | 870-895-5433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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