Provider Demographics
NPI:1043616212
Name:LIFESTYLES FOR THE DISABLED, INC.
Entity Type:Organization
Organization Name:LIFESTYLES FOR THE DISABLED, INC.
Other - Org Name:LIFESTYLES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SALINARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-983-5351
Mailing Address - Street 1:930 WILLOWBROOK RD
Mailing Address - Street 2:BUILDING 12G
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4209
Mailing Address - Country:US
Mailing Address - Phone:718-983-5351
Mailing Address - Fax:718-983-5383
Practice Address - Street 1:930 WILLOWBROOK RD
Practice Address - Street 2:BUILDING 12G
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4209
Practice Address - Country:US
Practice Address - Phone:718-983-5351
Practice Address - Fax:718-983-5383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02700067Medicaid
NY02002151Medicaid
NY01499581Medicaid
NY02591880Medicaid
NY03563926Medicaid
NY02225905Medicaid