Healthcare Provider Details

I. General information

NPI: 1295937712
Provider Name (Legal Business Name): LIFESKILLS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 SUWANNEE TRAIL ST
BOWLING GREEN KY
42103-7956
US

IV. Provider business mailing address

380 SUWANNEE TRAIL ST
BOWLING GREEN KY
42103-7956
US

V. Phone/Fax

Practice location:
  • Phone: 270-901-5000
  • Fax: 270-842-5268
Mailing address:
  • Phone: 270-901-5000
  • Fax: 270-842-5268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOE DAN BEAVERS
Title or Position: CEO
Credential:
Phone: 270-901-5000