Organization
LIFE SOURCE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. IRINA ETINGER (CPA)
(303) 231-1412
Entity
Organization
Contact information
Practice address
700 KINDERKAMACK RD STE 105, ORADELL, NJ 07649
(888) 865-5103
(201) 225-4769
Mailing address
245 S BENTON ST, LAKEWOOD, CO 80226-2453
(303) 231-1203
(303) 234-0124
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
22933
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8608709
—
NJ
Enumeration date
04/05/2006
Last updated
07/20/2018
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