Provider Demographics
NPI: | 1417546417 |
---|---|
Name: | LIFE SKILLS ENHANCEMENT SERVICES, LLC |
Entity Type: | Organization |
Organization Name: | LIFE SKILLS ENHANCEMENT SERVICES, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | PATRICIA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LAWSON CHUKWUDI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 757-373-1663 |
Mailing Address - Street 1: | 2085 LYNNHAVEN PKWY # 106-324 |
Mailing Address - Street 2: | |
Mailing Address - City: | VIRGINIA BEACH |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 23456-1497 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 757-373-1663 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2085 LYNNHAVEN PKWY # 106-324 |
Practice Address - Street 2: | |
Practice Address - City: | VIRGINIA BEACH |
Practice Address - State: | VA |
Practice Address - Zip Code: | 23456-1497 |
Practice Address - Country: | US |
Practice Address - Phone: | 757-373-1663 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-01-13 |
Last Update Date: | 2021-03-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 253Z00000X | Agencies | In Home Supportive Care | |
No | 251B00000X | Agencies | Case Management | |
No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | |
No | 261QA0600X | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care |
No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility | |
No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
No | 320700000X | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities | |
No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
No | 385H00000X | Respite Care Facility | Respite Care | |
No | 385HR2050X | Respite Care Facility | Respite Care | Respite Care Camp |
No | 385HR2055X | Respite Care Facility | Respite Care | Respite Care, Mental Illness, Child |
No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child |
No | 385HR2065X | Respite Care Facility | Respite Care | Respite Care, Physical Disabilities, Child |