Provider Demographics
NPI:1578046215
Name:LIFETIME SOLUTIONS AGENCY, LLC
Entity type:Organization
Organization Name:LIFETIME SOLUTIONS AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:RODRIGUEZ BLANDINO
Authorized Official - Suffix:
Authorized Official - Credentials:CBHCMS
Authorized Official - Phone:786-353-2616
Mailing Address - Street 1:5757 WATERFORD DISTRICT DR STE 172
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2076
Mailing Address - Country:US
Mailing Address - Phone:786-353-2616
Mailing Address - Fax:786-524-2880
Practice Address - Street 1:5757 WATERFORD DISTRICT DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2058
Practice Address - Country:US
Practice Address - Phone:954-613-7683
Practice Address - Fax:954-613-7693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-10
Last Update Date:2024-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management