Provider Demographics
NPI:1215543392
Name:LIFESTYLES UNLIMITED LLC
Entity Type:Organization
Organization Name:LIFESTYLES UNLIMITED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-444-7998
Mailing Address - Street 1:51 E JEFFERSON ST UNIT 1553
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32802-7565
Mailing Address - Country:US
Mailing Address - Phone:888-999-6607
Mailing Address - Fax:
Practice Address - Street 1:334 E HARVARD ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5550
Practice Address - Country:US
Practice Address - Phone:888-999-6607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health