Provider Demographics
NPI:1982754024
Name:LIFE SKILLS CENTERS, INC.
Entity Type:Organization
Organization Name:LIFE SKILLS CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:R
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-468-3682
Mailing Address - Street 1:53 CROCKER BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2550
Mailing Address - Country:US
Mailing Address - Phone:586-468-3682
Mailing Address - Fax:586-468-3694
Practice Address - Street 1:53 CROCKER
Practice Address - Street 2:
Practice Address - City:MT. CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2550
Practice Address - Country:US
Practice Address - Phone:586-468-3682
Practice Address - Fax:586-468-3694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services