Organization
LIFE COMMUNITY OUTREACH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLENA TUCKER (FOUNDER)
(531) 224-6446
Entity
Organization
Contact information
Practice address
3536 N 40TH AVE, OMAHA, NE 68111-2648
(531) 224-6446
Mailing address
3536 N 40TH AVE, OMAHA, NE 68111-2648
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1801660931
NPI
NE
Enumeration date
01/24/2024
Last updated
01/24/2024
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