Organization
LIFE DESIGN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SANDRA LEE ROBERTS (PROFESSIONAL SERVICE COORDINATOR)
(208) 242-3224
Entity
Organization
Contact information
Practice address
3420 ALTURAS CT, POCATELLO, ID 83201-8024
(208) 242-3224
(208) 237-3685
Mailing address
3420 ALTURAS CT, POCATELLO, ID 83201-8024
(208) 242-3224
(208) 237-3685
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
8078941
ID
251B00000X
Case Management Agency
Primary
8078982
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8078941
—
ID
05
—
8078982
—
ID
Enumeration date
01/04/2008
Last updated
02/24/2008
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