Provider Demographics
NPI:1821110669
Name:LIFESTYLE SUPPORT SERVICES INC
Entity Type:Organization
Organization Name:LIFESTYLE SUPPORT SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE IT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DELOZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-948-6708
Mailing Address - Street 1:1109 DEVEAUX STREET
Mailing Address - Street 2:PO BOX 303
Mailing Address - City:ELMORA
Mailing Address - State:PA
Mailing Address - Zip Code:15714-0303
Mailing Address - Country:US
Mailing Address - Phone:814-948-6708
Mailing Address - Fax:814-948-6718
Practice Address - Street 1:1109 DEVEAUX STREET
Practice Address - Street 2:
Practice Address - City:ELMORA
Practice Address - State:PA
Practice Address - Zip Code:15714-0303
Practice Address - Country:US
Practice Address - Phone:814-948-6708
Practice Address - Fax:814-948-6718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty