=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174777064
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFELONG INDEPENDENCE AND FITNESS ENRICHMENT CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2008
-----------------------------------------------------
Last Update Date | 11/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 GALLAGHER DR
-----------------------------------------------------
City | SHERMAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75090-1713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-870-7000
-----------------------------------------------------
Fax | 903-870-7188
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1111 GALLAGHER DR
-----------------------------------------------------
City | SHERMAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75090-1713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-870-7000
-----------------------------------------------------
Fax | 903-870-7188
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MS. JANIS G THOMPSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 903-870-7117
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283X00000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------