MEDICARE: LIFEWORKS INC

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	104100000X	Social Worker	04243	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417115718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFEWORKS INC

Provider Business Mailing Address
First Line	:	2213 GRAND AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50312-5305
Country	:	US
Telephone Number	:	515-237-3974
Fax Number	:	515-883-2692

Provider Business Practice Location Address
First Line	:	100 E EUCLID AVE
Second Line	:	SUITE 151
City	:	DES MOINES
State	:	IA
Zip	:	50313-4511
Country	:	US
Telephone Number	:	515-255-8399
Fax Number	:	515-255-8405

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	JOHN J STANLEY
Credential	:	LISW
Telephone Number	:	515-255-8399

Provider Enumeration Date	:	05/23/2008
Last Update Date	:	05/23/2008

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Directions to “LIFEWORKS INC ” Practice Location

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