Provider Demographics
NPI:1881937837
Name:LIFE WALK SOLUTIONS LLC
Entity type:Organization
Organization Name:LIFE WALK SOLUTIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-528-0467
Mailing Address - Street 1:7710 READING RD
Mailing Address - Street 2:SUTIE 112
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-6800
Mailing Address - Country:US
Mailing Address - Phone:513-528-0467
Mailing Address - Fax:513-528-0470
Practice Address - Street 1:7710 READING RD
Practice Address - Street 2:SUITE 112
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-6800
Practice Address - Country:US
Practice Address - Phone:513-528-0467
Practice Address - Fax:513-528-0470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13916251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health