MEDICARE: THE L.I.F.E. GROUP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103TM1800X	Intellectual & Developmental Disabilities Psychologist
2	251C00000X	Developmentally Disabled Services Day Training Agency
3	253Z00000X	In Home Supportive Care Agency
4	385H00000X	Respite Care
5	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

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

Provider Business Mailing Address
First Line	:	850 EUCLID AVE STE 8192431
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-3306
Country	:	US
Telephone Number	:	267-881-7013
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 EUCLID AVE STE 8192431
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-3306
Country	:	US
Telephone Number	:	267-881-7013
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	HAKIM ABDUL GLOVER
Credential	:
Telephone Number	:	267-881-7013

Provider Enumeration Date	:	12/16/2022
Last Update Date	:	12/16/2022

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