Provider Demographics
NPI:1649652645
Name:LIFESTYLES ACADEMY, INC.
Entity type:Organization
Organization Name:LIFESTYLES ACADEMY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAMINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-480-2085
Mailing Address - Street 1:10300 W 131ST ST
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-2207
Mailing Address - Country:US
Mailing Address - Phone:708-480-2085
Mailing Address - Fax:708-480-2659
Practice Address - Street 1:10300 W 131ST ST
Practice Address - Street 2:
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464-2207
Practice Address - Country:US
Practice Address - Phone:708-480-2085
Practice Address - Fax:708-480-2659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services