MEDICARE: LIFE RESOURCE AND DEVELOPEMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1518444900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE RESOURCE AND DEVELOPEMENT

Provider Business Mailing Address
First Line	:	3295 MEADE AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-4557
Country	:	US
Telephone Number	:	619-948-3708
Fax Number	:	858-684-1088

Provider Business Practice Location Address
First Line	:	3295 MEADE AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-4557
Country	:	US
Telephone Number	:	619-948-3708
Fax Number	:	858-684-1088

Authorized Official
Title or Position	:	PROGRAM MANAGER/ PRESIDENT
Name	:	MR. GREGORY HAMILTON
Credential	:	EDD (2018)
Telephone Number	:	619-948-3708

Provider Enumeration Date	:	07/27/2018
Last Update Date	:	07/27/2018

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Directions to “LIFE RESOURCE AND DEVELOPEMENT ” Practice Location

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