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General NPI Number Information
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NPI Number | 1871778183
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Entity Type | Organization
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Legal Business Name | LIFE DESIGN LLC
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Dates
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Enumeration Date | 01/04/2008
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Last Update Date | 02/24/2008
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Provider Practice Location Address
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Address Line | 3420 ALTURAS CT
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City | POCATELLO
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State | ID
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Zip | 83201-8024
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Country | US
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Telephone | 208-242-3224
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Fax | 208-237-3685
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Provider Business Mailing Address
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Address Line | 3420 ALTURAS CT
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City | POCATELLO
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State | ID
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Zip | 83201-8024
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Country | US
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Telephone | 208-242-3224
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Fax | 208-237-3685
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Authorized Official
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Title or Position | PROFESSIONAL SERVICE COORDINATOR
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Name | MS. SANDRA LEE ROBERTS
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Credential |
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Telephone | 208-242-3224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 8078941
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 8078982
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License Number State | ID
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