Provider Demographics
NPI:1285381889
Name:LIFE DEVELOPMENT & HEALTH SERVICES CORPORATION
Entity type:Organization
Organization Name:LIFE DEVELOPMENT & HEALTH SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:BENAMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-806-5347
Mailing Address - Street 1:12848 QUEENSBURY LN STE 208
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-4163
Mailing Address - Country:US
Mailing Address - Phone:866-806-5347
Mailing Address - Fax:216-710-6801
Practice Address - Street 1:2000 AUBURN DR STE 200
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4328
Practice Address - Country:US
Practice Address - Phone:866-806-5347
Practice Address - Fax:216-710-6801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFE DEVELOPMENT & HEALTH SERVICES CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty