# CENTER FOR LIFETIME HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Colleen Shackelford, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689744963
- **Authorized official:** COLLEEN SHACKELFORD DNP (OWNER)
- **Authorized official phone:** (208) 342-7400

## Contact information

- **Practice address:** 300 E BANNOCK ST, BOISE, ID 83712
- **Practice address phone:** (208) 342-7400
- **Practice address fax:** (208) 342-1879
- **Mailing address:** 300 E BANNOCK ST, BOISE, ID 83712
- **Mailing address phone:** (208) 342-7400
- **Mailing address fax:** (208) 342-1879

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | M5741 | ID | Yes |

## Other

- **Enumeration date:** 11/08/2006
- **Last updated:** 07/25/2023