Provider Demographics
NPI:1235497710
Name:LIFESTYLE HOSPICE FOUNDATION, INC.
Entity Type:Organization
Organization Name:LIFESTYLE HOSPICE FOUNDATION, INC.
Other - Org Name:LIFESTYLE HOME MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LELAND
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:FIFE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:541-216-6468
Mailing Address - Street 1:2390 SW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-1852
Mailing Address - Country:US
Mailing Address - Phone:541-216-6468
Mailing Address - Fax:541-216-6469
Practice Address - Street 1:2390 SW 4TH AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-1852
Practice Address - Country:US
Practice Address - Phone:541-216-6468
Practice Address - Fax:541-216-6469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORNPC-0003805332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies