MEDICARE: LIFE THERAPEUTIC SOLUTIONS, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1487024212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE THERAPEUTIC SOLUTIONS, INC

Provider Business Mailing Address
First Line	:	PO BOX 90002
Second Line	:
City	:	WYOMING
State	:	MI
Zip	:	49509-9919
Country	:	US
Telephone Number	:	616-828-5492
Fax Number	:	855-207-3270

Provider Business Practice Location Address
First Line	:	1208 GRISWOLD ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49507-3815
Country	:	US
Telephone Number	:	616-828-5492
Fax Number	:	855-207-3270

Authorized Official
Title or Position	:	OWNER
Name	:	KRISTINE SCHWAB
Credential	:	CTRS, ATRIC
Telephone Number	:	616-828-5492

Provider Enumeration Date	:	10/06/2015
Last Update Date	:	10/06/2015

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