Provider Demographics
NPI:1194114587
Name:LIFENET
Entity type:Organization
Organization Name:LIFENET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AIYANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-358-5993
Mailing Address - Street 1:P.O. BOX 31
Mailing Address - Street 2:
Mailing Address - City:YODER
Mailing Address - State:WY
Mailing Address - Zip Code:82244
Mailing Address - Country:US
Mailing Address - Phone:307-401-1004
Mailing Address - Fax:
Practice Address - Street 1:106 EAST 2ND AVE.
Practice Address - Street 2:
Practice Address - City:YODER
Practice Address - State:WY
Practice Address - Zip Code:82244
Practice Address - Country:US
Practice Address - Phone:307-401-1004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management