Provider Demographics
NPI:1255884946
Name:LIFESCAPE COMMUNITY SERVICES, INC.
Entity type:Organization
Organization Name:LIFESCAPE COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-963-1609
Mailing Address - Street 1:705 KILBURN AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61101-6550
Mailing Address - Country:US
Mailing Address - Phone:815-963-1609
Mailing Address - Fax:815-963-1627
Practice Address - Street 1:1901 1ST AVE
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-1203
Practice Address - Country:US
Practice Address - Phone:815-490-1125
Practice Address - Fax:815-626-3630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management