MEDICARE: ANOTHER LIFE FOUNDATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1164167250
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANOTHER LIFE FOUNDATION

Provider Business Mailing Address
First Line	:	5050 EDISON AVE STE 217
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80915-3540
Country	:	US
Telephone Number	:	719-216-7238
Fax Number	:

Provider Business Practice Location Address
First Line	:	5050 EDISON AVE STE 217
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80915-3540
Country	:	US
Telephone Number	:	719-216-7238
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. STEPHANIE GREEN
Credential	:
Telephone Number	:	719-216-7238

Provider Enumeration Date	:	05/03/2022
Last Update Date	:	05/03/2022

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Directions to “ANOTHER LIFE FOUNDATION ” Practice Location

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