Provider Demographics
NPI:1134405566
Name:LIFECENTER SKILLS FOR DEVELOPMENT
Entity type:Organization
Organization Name:LIFECENTER SKILLS FOR DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TEIZO
Authorized Official - Middle Name:DEVOTNAE
Authorized Official - Last Name:ADKISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-438-2574
Mailing Address - Street 1:9304 FOREST LANE
Mailing Address - Street 2:SUITE N271
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243
Mailing Address - Country:US
Mailing Address - Phone:469-438-2574
Mailing Address - Fax:972-584-9905
Practice Address - Street 1:9304 FOREST LANE
Practice Address - Street 2:SUITE N271
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243
Practice Address - Country:US
Practice Address - Phone:469-438-2574
Practice Address - Fax:972-584-9905
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFESPAN RESOURCES OF TEXAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility