Provider Demographics
NPI:1639436405
Name:LIFETIME MANAGEMENT LLC
Entity Type:Organization
Organization Name:LIFETIME MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-865-7505
Mailing Address - Street 1:1215 AVERY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-4412
Mailing Address - Country:US
Mailing Address - Phone:304-865-7505
Mailing Address - Fax:304-865-0233
Practice Address - Street 1:1215 AVERY ST
Practice Address - Street 2:SUITE A
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-4412
Practice Address - Country:US
Practice Address - Phone:304-865-7505
Practice Address - Fax:304-865-0233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810022725Medicaid