Provider Demographics
NPI:1114368867
Name:LIFE IDEALS, LLC
Entity type:Organization
Organization Name:LIFE IDEALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:BURKE
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-333-3507
Mailing Address - Street 1:178 LISBON ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7234
Mailing Address - Country:US
Mailing Address - Phone:207-333-3507
Mailing Address - Fax:
Practice Address - Street 1:178 LISBON ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7234
Practice Address - Country:US
Practice Address - Phone:207-333-3507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC83171041C0700X
MELC105971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty