Provider Demographics
NPI:1912061797
Name:LIVING 4 INDEPENDENCE
Entity type:Organization
Organization Name:LIVING 4 INDEPENDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:LEMOS
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:330-704-6580
Mailing Address - Street 1:4629 HELMSWORTH DR NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44714-1162
Mailing Address - Country:US
Mailing Address - Phone:330-704-6580
Mailing Address - Fax:330-265-2072
Practice Address - Street 1:4629 HELMSWORTH DR NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44714-1162
Practice Address - Country:US
Practice Address - Phone:330-704-6580
Practice Address - Fax:330-265-2072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities