Provider Demographics
NPI:1194484253
Name:LIFE REIMAGINED, LLC
Entity type:Organization
Organization Name:LIFE REIMAGINED, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BOMBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MFT0002086
Authorized Official - Phone:626-387-3736
Mailing Address - Street 1:9837 NEWLAND CT
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-5476
Mailing Address - Country:US
Mailing Address - Phone:505-400-0397
Mailing Address - Fax:
Practice Address - Street 1:8120 SHERIDAN BLVD STE 315C
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-6160
Practice Address - Country:US
Practice Address - Phone:626-387-3736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-15
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty