Healthcare Provider Details

I. General information

NPI: 1285059790
Provider Name (Legal Business Name): LIFE SKILLS TRAINING AND EDUCATIONAL PROGRAMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3247 RAMOS CIR
SACRAMENTO CA
95827-2501
US

IV. Provider business mailing address

3247 RAMOS CIR
SACRAMENTO CA
95827-2501
US

V. Phone/Fax

Practice location:
  • Phone: 916-965-0110
  • Fax: 916-965-0102
Mailing address:
  • Phone: 916-965-0110
  • Fax: 916-965-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: BETH SOUTHORN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 916-965-0110