Healthcare Provider Details

I. General information

NPI: 1437073483
Provider Name (Legal Business Name): LIFE SWITCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

647 GLENDORA AVE
AKRON OH
44320-1964
US

IV. Provider business mailing address

647 GLENDORA AVE
AKRON OH
44320-1964
US

V. Phone/Fax

Practice location:
  • Phone: 330-907-4391
  • Fax:
Mailing address:
  • Phone: 330-907-4391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRYAN LUTON
Title or Position: PROVIDER
Credential: LSW, LICDC
Phone: 330-907-4391