Provider Demographics
NPI:1275142713
Name:LIFESTYLE CARE AGENCY LLC
Entity Type:Organization
Organization Name:LIFESTYLE CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUPERIA
Authorized Official - Middle Name:
Authorized Official - Last Name:INGALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-266-3582
Mailing Address - Street 1:200 BARR HARBOR DR STE 400
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2978
Mailing Address - Country:US
Mailing Address - Phone:610-572-3565
Mailing Address - Fax:
Practice Address - Street 1:200 BARR HARBOR DR STE 400
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-2978
Practice Address - Country:US
Practice Address - Phone:610-572-3565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care