Provider Demographics
NPI:1407474737
Name:LIFE CYCLES DEVELOPMENT CENTER LLC
Entity Type:Organization
Organization Name:LIFE CYCLES DEVELOPMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRAY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:234-788-9329
Mailing Address - Street 1:811 FREDERICK BLVD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-1717
Mailing Address - Country:US
Mailing Address - Phone:234-788-9329
Mailing Address - Fax:
Practice Address - Street 1:1507 COPLEY RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-2501
Practice Address - Country:US
Practice Address - Phone:234-571-2163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0293192Medicaid