Provider Demographics
NPI:1912358326
Name:LIFE SKILLS RESOURCE CENTER
Entity Type:Organization
Organization Name:LIFE SKILLS RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:EDM
Authorized Official - Phone:908-927-1110
Mailing Address - Street 1:PO BOX 935
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-0935
Mailing Address - Country:US
Mailing Address - Phone:908-927-1110
Mailing Address - Fax:
Practice Address - Street 1:10 MALLARD RD
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4605
Practice Address - Country:US
Practice Address - Phone:908-927-1110
Practice Address - Fax:908-927-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJGH756320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities