Provider Demographics
NPI:1659681104
Name:ASSISTED LIFESTYLE, INC.
Entity Type:Organization
Organization Name:ASSISTED LIFESTYLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-662-9911
Mailing Address - Street 1:470 N BROAD ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-3083
Mailing Address - Country:US
Mailing Address - Phone:704-662-9911
Mailing Address - Fax:
Practice Address - Street 1:470 N BROAD ST
Practice Address - Street 2:SUITE E
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-3083
Practice Address - Country:US
Practice Address - Phone:704-662-9911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
NCHC22453747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty