Provider Demographics
NPI:1821754193
Name:LIFE DEVELOPMENT & HEALTH SERVICES
Entity Type:Organization
Organization Name:LIFE DEVELOPMENT & HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:BENAMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-806-5347
Mailing Address - Street 1:12848 QUEENSBURY LN STE 208
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-4163
Mailing Address - Country:US
Mailing Address - Phone:866-806-5347
Mailing Address - Fax:216-710-6801
Practice Address - Street 1:12848 QUEENSBURY LN STE 208
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-4163
Practice Address - Country:US
Practice Address - Phone:866-806-5347
Practice Address - Fax:216-710-6801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No251V00000XAgenciesVoluntary or CharitableGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy