Provider Demographics
NPI:1457186959
Name:LIFESKILLS AUTISM SERVICES
Entity type:Organization
Organization Name:LIFESKILLS AUTISM SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ONYECHI
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:240-299-3987
Mailing Address - Street 1:1300 MERCANTILE LN STE 129-5
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5327
Mailing Address - Country:US
Mailing Address - Phone:240-299-3987
Mailing Address - Fax:240-764-6789
Practice Address - Street 1:1300 MERCANTILE LN STE 129-5
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5327
Practice Address - Country:US
Practice Address - Phone:240-299-3987
Practice Address - Fax:240-764-6789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty