Provider Demographics
NPI:1548563745
Name:LIFESTYLES COLLEGE OF DEVELOPMENT
Entity Type:Organization
Organization Name:LIFESTYLES COLLEGE OF DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOTS-CID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-678-0078
Mailing Address - Street 1:440 SE 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5211
Mailing Address - Country:US
Mailing Address - Phone:561-450-6320
Mailing Address - Fax:561-865-5628
Practice Address - Street 1:440 SE 5TH AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5211
Practice Address - Country:US
Practice Address - Phone:561-450-6320
Practice Address - Fax:561-865-5628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder