MEDICARE: LIFE TOWN LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	343900000X	Non-emergency Medical Transport (VAN)
3	347C00000X	Private Vehicle
4	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1073270963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE TOWN LLC

Provider Business Mailing Address
First Line	:	3970 LARDNER LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80916-2823
Country	:	US
Telephone Number	:	719-200-6487
Fax Number	:

Provider Business Practice Location Address
First Line	:	3970 LARDNER LANE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80916-8091
Country	:	US
Telephone Number	:	719-299-6487
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. CONNIE BROOKS
Credential	:
Telephone Number	:	719-200-6487

Provider Enumeration Date	:	11/26/2021
Last Update Date	:	10/14/2022

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Directions to “LIFE TOWN LLC ” Practice Location

Language	Start Address	Practice Location

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