Provider Demographics
NPI:1346772738
Name:LIFESTAGES PHYSICIAN SERVICES LLC
Entity Type:Organization
Organization Name:LIFESTAGES PHYSICIAN SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:HILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-757-3326
Mailing Address - Street 1:50 FODEN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-1718
Mailing Address - Country:US
Mailing Address - Phone:800-757-3326
Mailing Address - Fax:207-772-0698
Practice Address - Street 1:50 FODEN RD
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-1718
Practice Address - Country:US
Practice Address - Phone:800-757-3326
Practice Address - Fax:207-772-0698
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VNA HOME HEALTH & HOSPICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care