=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154768687
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LINKS TO LIFE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2013
-----------------------------------------------------
Last Update Date | 05/23/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 147 MILL RIDGE RD SUITE 200
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24502-4341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-509-6060
-----------------------------------------------------
Fax | 434-332-4362
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 147 MILL RIDGE RD SUITE 200
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24502-4341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-509-6060
-----------------------------------------------------
Fax | 434-332-4362
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF SERVICES/PARTNER
-----------------------------------------------------
Name | MS. SHARON JOHNSON ROBINSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 434-213-5695
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number | 1822-08-011
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------