Healthcare Provider Details

I. General information

NPI: 1154690956
Provider Name (Legal Business Name): LIFETIME LEARNING & SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11565 LONE DESERT DR
RENO NV
89506-5566
US

IV. Provider business mailing address

11565 LONE DESERT DR
RENO NV
89506-5566
US

V. Phone/Fax

Practice location:
  • Phone: 775-972-9318
  • Fax:
Mailing address:
  • Phone: 775-972-9318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: GABRIELLE ENFIELD
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MPA
Phone: 775-972-9318