Provider Demographics
NPI:1487801700
Name:LIFETIME MANAGEMENT SERVICES LLC
Entity type:Organization
Organization Name:LIFETIME MANAGEMENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:KIGER
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:304-428-7505
Mailing Address - Street 1:1215 AVERY ST STE A
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-4412
Mailing Address - Country:US
Mailing Address - Phone:304-428-7505
Mailing Address - Fax:304-428-3854
Practice Address - Street 1:1215 AVERY ST STE A
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-4412
Practice Address - Country:US
Practice Address - Phone:304-428-7505
Practice Address - Fax:304-428-3854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4703010000Medicaid