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General NPI Number Information
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NPI Number | 1144505488
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Entity Type | Organization
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Legal Business Name | LIFE CENTER, INC.
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 08/31/2022
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Provider Practice Location Address
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Address Line | 411 W MATTHEWS AVE
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City | STILLWATER
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State | OK
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Zip | 74075-7517
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Country | US
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Telephone | 405-377-0978
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Fax | 405-372-7726
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Provider Business Mailing Address
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Address Line | 411 W MATTHEWS AVE
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City | STILLWATER
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State | OK
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Zip | 74075-7517
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Country | US
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Telephone | 405-377-0978
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Fax | 405-372-7726
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KRISTY A MOORMAN
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Credential | TRS/L
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Telephone | 405-377-0978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | DC6001-6001
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License Number State | OK
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