Provider Demographics
NPI:1073195483
Name:LIFEGUIDE, LLC
Entity Type:Organization
Organization Name:LIFEGUIDE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLUSHOLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-345-8732
Mailing Address - Street 1:1416 NE 5TH CT APT 4
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-1272
Mailing Address - Country:US
Mailing Address - Phone:850-345-8732
Mailing Address - Fax:
Practice Address - Street 1:1416 NE 5TH CT APT 4
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-1272
Practice Address - Country:US
Practice Address - Phone:850-345-8732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL834950Medicaid