Provider Demographics
NPI:1417573221
Name:LIFEWORTHY
Entity Type:Organization
Organization Name:LIFEWORTHY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:419-984-4208
Mailing Address - Street 1:1767 HINSDALE DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2663
Mailing Address - Country:US
Mailing Address - Phone:419-984-4208
Mailing Address - Fax:
Practice Address - Street 1:7318 INTERNATIONAL DR STE B
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-9560
Practice Address - Country:US
Practice Address - Phone:419-984-4208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty