Provider Demographics
NPI:1457423006
Name:LIFE CYCLES GUARDIANSHIP FOUNDATION, INC.
Entity Type:Organization
Organization Name:LIFE CYCLES GUARDIANSHIP FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:WALLACE
Authorized Official - Last Name:TUTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, RG, CMC
Authorized Official - Phone:813-933-2030
Mailing Address - Street 1:8910 N DALE MABRY HWY
Mailing Address - Street 2:SUITE 23
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-1591
Mailing Address - Country:US
Mailing Address - Phone:813-933-2030
Mailing Address - Fax:813-933-2070
Practice Address - Street 1:8910 N DALE MABRY HWY
Practice Address - Street 2:SUITE 23
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-1591
Practice Address - Country:US
Practice Address - Phone:813-933-2030
Practice Address - Fax:813-933-2070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty