Provider Demographics
NPI:1174828834
Name:LIFESTYLES COLLEGE OF DEVELOPMENT
Entity Type:Organization
Organization Name:LIFESTYLES COLLEGE OF DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-746-8232
Mailing Address - Street 1:1705 S FEDERAL HWY
Mailing Address - Street 2:SUITE A5
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-3328
Mailing Address - Country:US
Mailing Address - Phone:954-746-8232
Mailing Address - Fax:
Practice Address - Street 1:1705 S FEDERAL HWY
Practice Address - Street 2:SUITE A5
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-3328
Practice Address - Country:US
Practice Address - Phone:954-746-8232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility