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NPI Code Detail

MEDICARE: LIFEWORKS BEHAVIORAL HEALTH LLC

MEDICARE: LIFEWORKS BEHAVIORAL HEALTH LLC
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750027538
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFEWORKS BEHAVIORAL HEALTH LLC
Provider Business Mailing Address
First Line : 858 ROANOKE RD
Second Line :
City : CLEVELAND HEIGHTS
State : OH
Zip : 44121-2054
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 17325 EUCLID AVE STE 3040
Second Line :
City : CLEVELAND
State : OH
Zip : 44112-1276
Country : US
Telephone Number : 216-525-3775
Fax Number :
Authorized Official
Title or Position : CREDENTIALING MANAGER
Name : LISA SULLIVAN
Credential :
Telephone Number : 440-453-0754
Provider Enumeration Date : 05/05/2022
Last Update Date : 03/17/2023

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Directions to “LIFEWORKS BEHAVIORAL HEALTH LLC ” Practice Location

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