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General NPI Number Information
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NPI Number | 1659484053
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Entity Type | Organization
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Legal Business Name | LIFE SERVICE PROFESSIONAL CORP
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1015 N SHELBY ST
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City | GARY
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State | IN
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Zip | 46403-1446
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Country | US
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Telephone | 219-938-0920
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Fax | 219-938-0923
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Provider Business Mailing Address
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Address Line | 1015 N SHELBY ST
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City | GARY
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State | IN
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Zip | 46403-1446
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Country | US
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Telephone | 219-938-0920
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Fax | 219-938-0923
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. GERALDINE BARRON-SIMPSON
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Credential |
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Telephone | 219-938-0920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | IN
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