| Lyfe Intervention Services | |
|
401 Putman Street Fountain Inn SC 29644 | |
| (864) 862-6912 | |
| Not Available |
| Full Name | Lyfe Intervention Services |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 401 Putman Street, Fountain Inn, South Carolina |
| Authorized Official Name and Position | Darius Durand Lagroon (CEO) |
| Authorized Official Contact | 8648626912 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lyfe Intervention Services 401 Putman Street Fountain Inn SC 29644 Ph: (864) 862-6912 | Lyfe Intervention Services 401 Putman Street Fountain Inn SC 29644 Ph: (864) 862-6912 |
| NPI Number | 1164791778 |
|---|---|
| Provider Enumeration Date | 12/28/2011 |
| Last Update Date | 12/28/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164791778 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 251S00000X (South Carolina) | Primary |
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