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General NPI Number Information
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NPI Number | 1255884946
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Entity Type | Organization
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Legal Business Name | LIFESCAPE COMMUNITY SERVICES, INC.
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Dates
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Enumeration Date | 07/28/2016
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Last Update Date | 07/28/2016
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Provider Practice Location Address
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Address Line | 1901 1ST AVE
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City | STERLING
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State | IL
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Zip | 61081-1203
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Country | US
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Telephone | 815-490-1125
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Fax | 815-626-3630
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Provider Business Mailing Address
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Address Line | 705 KILBURN AVE
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City | ROCKFORD
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State | IL
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Zip | 61101-6550
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Country | US
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Telephone | 815-963-1609
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Fax | 815-963-1627
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MIKE HUGHES
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Credential |
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Telephone | 815-963-1609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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