Provider Demographics
NPI:1679117113
Name:LIFESTYLE COMMUNITY SERVICES LLC
Entity Type:Organization
Organization Name:LIFESTYLE COMMUNITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YAMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ CONCEPCION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-802-9929
Mailing Address - Street 1:2460 SW 137TH AVE STE 251-252
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-8803
Mailing Address - Country:US
Mailing Address - Phone:315-802-9929
Mailing Address - Fax:
Practice Address - Street 1:2460 SW 137TH AVE STE 251-252
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-8803
Practice Address - Country:US
Practice Address - Phone:315-802-9929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management