Provider Demographics
NPI:1932173010
Name:LIFESTYLES 1 HEALTHCARE LLC
Entity Type:Organization
Organization Name:LIFESTYLES 1 HEALTHCARE LLC
Other - Org Name:WRIGHT'S NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:KELSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-391-9986
Mailing Address - Street 1:11300 110TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33778-3711
Mailing Address - Country:US
Mailing Address - Phone:727-391-9986
Mailing Address - Fax:727-456-5555
Practice Address - Street 1:11300 110TH AVE
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33778-3711
Practice Address - Country:US
Practice Address - Phone:727-391-9986
Practice Address - Fax:727-456-5555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1614096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL4BOtherBCBS
FLL4BOtherBCBS