Organization
LIFE, A CENTER FOR INDEPENDENT LIVING
Active
Other names
LIFE, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL LEFEVOR (EXECUTIVE DIRECTOR)
(208) 232-2747
Entity
Organization
Contact information
Practice address
640 PERSHING AVE, 1, POCATELLO, ID 83201-3702
(208) 232-2747
(208) 232-2753
Mailing address
640 PERSHING AVE, 1, POCATELLO, ID 83201-3702
(208) 232-2747
(208) 232-2753
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
M8054374
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
M8054374
—
ID
Enumeration date
12/03/2013
Last updated
05/21/2025
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