1386120194 NPI number — LIFESKILLS, LLC

Table of content: (NPI 1386120194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386120194 NPI number — LIFESKILLS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFESKILLS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386120194
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1919 NE KNOLLBROOK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEES SUMMIT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64086-3458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-606-7127
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5460 BUENA VISTA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROELAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66205-2441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-606-7127
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARZA
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OPERATIONS MANAGER
Authorized Official Telephone Number:
816-606-7127

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TB0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC1900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8919243 . This is a "BUSINESS ENTITY ID NUMBER" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".