Healthcare Provider Details

I. General information

NPI: 1922716935
Provider Name (Legal Business Name): LIFE OUT LOUD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 11/08/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 1/2 WEST WASHINGTON STREET
SANDUSKY OH
44870
US

IV. Provider business mailing address

904 1/2 WEST WASHINGTON STREET
SANDUSKY OH
44870
US

V. Phone/Fax

Practice location:
  • Phone: 419-502-2037
  • Fax: 419-502-2036
Mailing address:
  • Phone: 440-413-0086
  • Fax: 419-502-2036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
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 Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MISS LISA ANN COOPER
Title or Position: CEO
Credential: M. ED.
Phone: 440-413-0086