Provider Demographics
NPI:1770032534
Name:LIFESKILLS DEVELOPMENT
Entity type:Organization
Organization Name:LIFESKILLS DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:BESSE
Authorized Official - Suffix:
Authorized Official - Credentials:QMHA, MDIV, PSYD
Authorized Official - Phone:917-981-0503
Mailing Address - Street 1:6095 SHEPHERD DR
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-2251
Mailing Address - Country:US
Mailing Address - Phone:917-981-0503
Mailing Address - Fax:
Practice Address - Street 1:6095 SHEPHERD DR
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-2251
Practice Address - Country:US
Practice Address - Phone:917-981-0503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility