Provider Demographics
NPI:1558637108
Name:LIFESTYLES HOMECARE
Entity Type:Organization
Organization Name:LIFESTYLES HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:765-378-0855
Mailing Address - Street 1:PO BOX 353
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47334-0353
Mailing Address - Country:US
Mailing Address - Phone:765-378-0855
Mailing Address - Fax:765-378-0858
Practice Address - Street 1:14425 W. HAZEL ST.
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:IN
Practice Address - Zip Code:47334
Practice Address - Country:US
Practice Address - Phone:765-378-0855
Practice Address - Fax:765-378-0858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11-012685-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health