Provider Demographics
NPI:1003016668
Name:LIFESTYLE HEARING CORPORATION USA INC.
Entity Type:Organization
Organization Name:LIFESTYLE HEARING CORPORATION USA INC.
Other - Org Name:HILTON HEAD HEARING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP-NATIONAL INSURANCE ADMINISTRATIO
Authorized Official - Prefix:
Authorized Official - First Name:NAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLACHANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-821-6715
Mailing Address - Street 1:23 MAIN ST
Mailing Address - Street 2:STE 101A
Mailing Address - City:HILTON HEADISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-6607
Mailing Address - Country:US
Mailing Address - Phone:843-681-6070
Mailing Address - Fax:843-681-6673
Practice Address - Street 1:23 MAIN ST
Practice Address - Street 2:STE 101A
Practice Address - City:HILTON HEADISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-6607
Practice Address - Country:US
Practice Address - Phone:843-681-6070
Practice Address - Fax:843-681-6673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3236231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA 0409 GP1710Medicaid
SC20066267OtherSELECT HEALTH OF SC
SCSA 0409 GP1710Medicaid