Healthcare Provider Details

I. General information

NPI: 1154033512
Provider Name (Legal Business Name): THE L.I.F.E. GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 EUCLID AVE STE 8192431
CLEVELAND OH
44114-3306
US

IV. Provider business mailing address

850 EUCLID AVE STE 8192431
CLEVELAND OH
44114-3306
US

V. Phone/Fax

Practice location:
  • Phone: 267-881-7013
  • Fax:
Mailing address:
  • Phone: 267-881-7013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: HAKIM ABDUL GLOVER
Title or Position: CEO
Credential:
Phone: 267-881-7013