Provider Demographics
NPI:1013299908
Name:DYNAMIC LIFESKILLS INC
Entity type:Organization
Organization Name:DYNAMIC LIFESKILLS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SYLVESTER
Authorized Official - Middle Name:OKUMU
Authorized Official - Last Name:OLUOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-529-9590
Mailing Address - Street 1:1516 SYLVAN LN
Mailing Address - Street 2:201
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-2482
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1516 SYLVAN LN
Practice Address - Street 2:201
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-2482
Practice Address - Country:US
Practice Address - Phone:573-529-9590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care