Organization
LIFECRAFT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTY JO PUTNAM (MANAGER)
(269) 612-7222
Entity
Organization
Contact information
Practice address
515 LINCOLNWAY, LA PORTE, IN 46350-3363
(269) 612-7222
Mailing address
515 LINCOLNWAY, LA PORTE, IN 46350-3363
(269) 612-7222
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
—
—
175T00000X
Peer Specialist
—
—
2255A2300X
Athletic Trainer
—
—
225800000X
Recreation Therapist
Primary
—
—
226000000X
Recreational Therapist Assistant
—
—
Other
Enumeration date
05/13/2021
Last updated
05/13/2021
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