Provider Demographics
NPI:1043628522
Name:LIFE STEPS, LLC
Entity Type:Organization
Organization Name:LIFE STEPS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-232-7290
Mailing Address - Street 1:PO BOX 4682
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33424-4682
Mailing Address - Country:US
Mailing Address - Phone:954-232-7290
Mailing Address - Fax:
Practice Address - Street 1:901 N CONGRESS AVE
Practice Address - Street 2:SUITE B102
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3316
Practice Address - Country:US
Practice Address - Phone:888-357-8377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder