Organization
LIFE CHRISTAIN OUTREACH
Active
Other names
Life Enterprises
Organization subpart
No
Provider details
NPI number
Authorized official
GREG ORDWAY (VICE PRESIDENT)
(573) 256-6155
Entity
Organization
Contact information
Practice address
3251 PINETREE DR, COLUMBIA, MO 65201-1706
(573) 875-1141
Mailing address
1250 N DOZIER STATION RD, COLUMBIA, MO 65202-7798
(573) 256-6155
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
856254206
—
MO
Enumeration date
01/07/2013
Last updated
01/08/2013
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