Provider Demographics
NPI:1861791212
Name:LIVIN' LIFE
Entity type:Organization
Organization Name:LIVIN' LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:SPAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MSM
Authorized Official - Phone:563-212-3237
Mailing Address - Street 1:1406 9TH ST
Mailing Address - Street 2:APT. 11
Mailing Address - City:DE WITT
Mailing Address - State:IA
Mailing Address - Zip Code:52742-1272
Mailing Address - Country:US
Mailing Address - Phone:563-212-3237
Mailing Address - Fax:
Practice Address - Street 1:1406 9TH ST
Practice Address - Street 2:APT. 11
Practice Address - City:DE WITT
Practice Address - State:IA
Practice Address - Zip Code:52742-1272
Practice Address - Country:US
Practice Address - Phone:563-212-3237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health