Provider Demographics
NPI:1912297714
Name:LIFESTYLE MOBILITY PLUS, INC.
Entity Type:Organization
Organization Name:LIFESTYLE MOBILITY PLUS, INC.
Other - Org Name:LIFESTYLE MOBILITY PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-610-4375
Mailing Address - Street 1:13256 SAXONY BLVD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-6288
Mailing Address - Country:US
Mailing Address - Phone:765-610-4375
Mailing Address - Fax:
Practice Address - Street 1:13256 SAXONY BLVD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-6288
Practice Address - Country:US
Practice Address - Phone:765-610-4375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies