Healthcare Provider Details

I. General information

NPI: 1194424374
Provider Name (Legal Business Name): LIFE GUIDE FRIENDS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 TYLER ST
NAPOLEON OH
43545-1507
US

IV. Provider business mailing address

712 TYLER ST
NAPOLEON OH
43545-1507
US

V. Phone/Fax

Practice location:
  • Phone: 419-913-7570
  • Fax:
Mailing address:
  • Phone: 419-913-7570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW R WATSON
Title or Position: MEMBER
Credential:
Phone: 419-913-7570