Healthcare Provider Details

I. General information

NPI: 1164203170
Provider Name (Legal Business Name): LIFE BUILDERS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7413 MAXTOWN RD
WESTERVILLE OH
43082-9040
US

IV. Provider business mailing address

7413 MAXTOWN RD
WESTERVILLE OH
43082-9040
US

V. Phone/Fax

Practice location:
  • Phone: 614-305-5156
  • Fax:
Mailing address:
  • Phone: 614-305-5156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEEDRA OLNEY
Title or Position: CEO
Credential:
Phone: 614-330-5235