Provider Demographics
NPI:1629249214
Name:ULTIMATE LIFESTYLE CENTER
Entity Type:Organization
Organization Name:ULTIMATE LIFESTYLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MACHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LISITSA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MFT
Authorized Official - Phone:310-272-6666
Mailing Address - Street 1:5012 S LA BREA AVE
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-1863
Mailing Address - Country:US
Mailing Address - Phone:323-290-0200
Mailing Address - Fax:
Practice Address - Street 1:5012 S LA BREA AVE
Practice Address - Street 2:SUITES # 2-5
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90056-1863
Practice Address - Country:US
Practice Address - Phone:323-290-0200
Practice Address - Fax:323-290-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable