Provider Demographics
NPI:1023249778
Name:LIFETIME HEALTH CARE SERVICES INC
Entity type:Organization
Organization Name:LIFETIME HEALTH CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-679-1113
Mailing Address - Street 1:2361 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-1984
Mailing Address - Country:US
Mailing Address - Phone:614-679-1113
Mailing Address - Fax:614-754-6635
Practice Address - Street 1:2361 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-1984
Practice Address - Country:US
Practice Address - Phone:614-679-1113
Practice Address - Fax:614-754-6635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN=========Medicare PIN