Provider Demographics
NPI:1831227370
Name:LIFESTYLES & HEALTHCARE LTD.
Entity type:Organization
Organization Name:LIFESTYLES & HEALTHCARE LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAVERLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-357-2442
Mailing Address - Street 1:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34973-0728
Mailing Address - Country:US
Mailing Address - Phone:863-763-2226
Mailing Address - Fax:863-763-0186
Practice Address - Street 1:1646 US HIGHWAY 441 N
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1916
Practice Address - Country:US
Practice Address - Phone:863-763-2226
Practice Address - Fax:863-763-0186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1388096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020254100Medicaid
FL105484Medicare ID - Type UnspecifiedPROVIDER NUMBER
FL020254100Medicaid