Provider Demographics
NPI:1003272519
Name:ULTIMATE LIFESTYLE TRANSFORMATION, LLC
Entity Type:Organization
Organization Name:ULTIMATE LIFESTYLE TRANSFORMATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-727-9488
Mailing Address - Street 1:309 EAGLETONE ESTATES DRIVE.
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418
Mailing Address - Country:US
Mailing Address - Phone:561-727-9488
Mailing Address - Fax:561-658-2434
Practice Address - Street 1:600 HERITAGE DRIVE.
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:561-727-9488
Practice Address - Fax:561-658-2435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder