Provider Demographics
NPI:1639338239
Name:DOMINION LIFESTYLE SERIVCES, LLC
Entity Type:Organization
Organization Name:DOMINION LIFESTYLE SERIVCES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR / OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:TURNER
Authorized Official - Last Name:SIVELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-753-2503
Mailing Address - Street 1:5368 MORTONS FORD WAY
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-4520
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5368 MORTONS FORD WAY
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-4520
Practice Address - Country:US
Practice Address - Phone:703-753-2503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health