Provider Demographics
NPI:1134328289
Name:LIFESPAN LEARNING COMMUNITIES
Entity Type:Organization
Organization Name:LIFESPAN LEARNING COMMUNITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-477-7004
Mailing Address - Street 1:16706 CHILLICOTHE RD
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-4573
Mailing Address - Country:US
Mailing Address - Phone:440-708-2219
Mailing Address - Fax:440-708-1879
Practice Address - Street 1:16706 CHILLICOTHE RD
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-4573
Practice Address - Country:US
Practice Address - Phone:440-708-2219
Practice Address - Fax:440-708-1879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2727124Medicaid