MEDICARE: LIFESTYLE SECURE 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
1	333300000X	Emergency Response System Companies		VA

General Provider Information

NPI Number	:	1952661142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESTYLE SECURE LLC

Provider Business Mailing Address
First Line	:	PO BOX 17152
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-7152
Country	:	US
Telephone Number	:	804-441-2539
Fax Number	:

Provider Business Practice Location Address
First Line	:	7709 CORNWALL RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23229-6803
Country	:	US
Telephone Number	:	804-364-4909
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. JOHN STROZIER III
Credential	:
Telephone Number	:	804-441-2539

Provider Enumeration Date	:	05/21/2012
Last Update Date	:	05/21/2012

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Directions to “LIFESTYLE SECURE LLC ” Practice Location

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