Life Bridge LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

LIFE BRIDGE LLC

Doing business as

Life Bridge

Practice address

3722 Whipple Ave NW
Canton, OH 44718-2934

Phone

(330) 324-7785

NPI assigned

Oct 17, 2022

Last updated

Oct 17, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jason Shaffer, PHD

Title

Ceo

Phone

(330) 324-7785

Specialties & licenses 1

Addresses

Other names 1

• Life Bridge Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1665964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665964800000",
    "number": "1710603113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3722 WHIPPLE AVE NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182934",
            "telephone_number": "330-324-7785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3722 WHIPPLE AVE NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182934",
            "telephone_number": "330-324-7785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE BRIDGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-17",
        "last_updated": "2022-10-17",
        "certification_date": "2022-10-12",
        "status": "A",
        "authorized_official_last_name": "SHAFFER",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "330-324-7785",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life Bridge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ronald Stephen Lewis, RPH, MBA
• Tatyanah Lewis
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• Jeremy Liebman, M.D.
• Teri Ann Lieser, CNS
• Life Bridge Services
• Life Simplified, LLC
• Lifecare Family Health and Dental Center, Inc (Canton Community Clinic)
• Lifecare Family Health and Dental Center, Inc
• Lifecare Family Health and Dental Center, Inc (Canton Community Clinic)

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Canton, OH
• Providers in Canton, OH by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.