Provider Demographics
NPI:1881144244
Name:LIFE SKILLS SERVICE CENTER OF THE VILLAGES, FL INC.
Entity type:Organization
Organization Name:LIFE SKILLS SERVICE CENTER OF THE VILLAGES, FL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AVON
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMBRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-257-5636
Mailing Address - Street 1:3515 WEDGEWOOD LN
Mailing Address - Street 2:113
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-7187
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13951 7TH ST
Practice Address - Street 2:5
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-4903
Practice Address - Country:US
Practice Address - Phone:352-257-5636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health