Provider Demographics
NPI:1043919400
Name:LIFESTYLE CARE PROFESSIONALS LLC
Entity Type:Organization
Organization Name:LIFESTYLE CARE PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SIERA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-960-8913
Mailing Address - Street 1:1218 ASTOR COMMONS PL APT 301
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-3731
Mailing Address - Country:US
Mailing Address - Phone:850-960-8892
Mailing Address - Fax:
Practice Address - Street 1:1218 ASTOR COMMONS PL APT 301
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-3731
Practice Address - Country:US
Practice Address - Phone:850-960-8892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services