Healthcare Provider Details

I. General information

NPI: 1558820498
Provider Name (Legal Business Name): LIFE SOLUTIONS SOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 02/25/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2728 EUCLID AVE STE 400
CLEVELAND OH
44115-2429
US

IV. Provider business mailing address

2728 EUCLID AVE STE 400
CLEVELAND OH
44115-2429
US

V. Phone/Fax

Practice location:
  • Phone: 216-539-2410
  • Fax: 800-901-0720
Mailing address:
  • Phone: 216-529-4289
  • Fax: 800-901-0720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. GIA HOPKINS
Title or Position: HUMAN RESOURCE SPECIALIST/OWNER
Credential:
Phone: 216-236-3028