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General NPI Number Information
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NPI Number | 1427202191
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Entity Type | Organization
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Legal Business Name | LIFELONG INDEPENDENCE AND FITNESS ENRICHMENT CENTER, INC.
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Dates
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Enumeration Date | 11/07/2008
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Last Update Date | 11/30/2009
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Provider Practice Location Address
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Address Line | 1111 GALLAGHER DR
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City | SHERMAN
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State | TX
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Zip | 75090-1713
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Country | US
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Telephone | 903-870-7000
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Fax | 903-870-7188
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Provider Business Mailing Address
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Address Line | 1111 GALLAGHER DR
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City | SHERMAN
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State | TX
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Zip | 75090-1713
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Country | US
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Telephone | 903-870-7000
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Fax | 903-870-7188
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. JANIS G THOMPSON
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Credential |
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Telephone | 903-870-7117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 284300000X
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Taxonomy Name | Special Hospital
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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 | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 008753
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License Number State | TX
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