Provider Demographics
NPI:1558743476
Name:COMMUNITY LIFESTYLE SERVICES LLC
Entity Type:Organization
Organization Name:COMMUNITY LIFESTYLE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:FARRELL
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-241-0998
Mailing Address - Street 1:PO BOX 529
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-0529
Mailing Address - Country:US
Mailing Address - Phone:806-241-0998
Mailing Address - Fax:
Practice Address - Street 1:2912 68TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-6312
Practice Address - Country:US
Practice Address - Phone:806-241-0998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-27
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home