Organization
LIFESOURCE,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER THOMAS KAUFFMAN MA (PRESIDENT)
(541) 409-1206
Entity
Organization
Contact information
Practice address
1266 44TH AVE, SWEET HOME, OR 97386-1235
(541) 409-1206
(541) 367-1995
Mailing address
PO BOX 724, FOSTER, OR 97345-0724
(541) 409-1206
(541) 367-1995
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
C0734
OR
Other
Enumeration date
07/09/2013
Last updated
07/09/2013
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