MEDICARE: SYSTEM MODILATION AND INTEGRATION FOR LIFESTYLE ENHANCEMENT

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	333300000X	Emergency Response System Companies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922271303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYSTEM MODILATION AND INTEGRATION FOR LIFESTYLE ENHANCEMENT

Provider Business Mailing Address
First Line	:	24000 MERCANTILE RD STE 1
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44122-5913
Country	:	US
Telephone Number	:	216-470-9088
Fax Number	:

Provider Business Practice Location Address
First Line	:	24000 MERCANTILE RD STE 1
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44122-5913
Country	:	US
Telephone Number	:	216-470-9088
Fax Number	:	216-663-2440

Authorized Official
Title or Position	:	VP SALES
Name	:	MR. ERIC GOLUBITSKY
Credential	:
Telephone Number	:	216-470-9088

Provider Enumeration Date	:	04/08/2008
Last Update Date	:	04/08/2008

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