| Lifesource,inc | |
|
1266 44th Ave Sweet Home OR 97386-1235 | |
| (541) 409-1206 | |
| (541) 367-1995 |
| Full Name | Lifesource,inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1266 44th Ave, Sweet Home, Oregon |
| Authorized Official Name and Position | Peter Thomas Kauffman (PRESIDENT) |
| Authorized Official Contact | 5414091206 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifesource,inc Po Box 724 Foster OR 97345-0724 Ph: (541) 409-1206 | Lifesource,inc 1266 44th Ave Sweet Home OR 97386-1235 Ph: (541) 409-1206 |
| NPI Number | 1073954806 |
|---|---|
| Provider Enumeration Date | 07/09/2013 |
| Last Update Date | 07/09/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073954806 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | C0734 (Oregon) | Primary |
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