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General NPI Number Information
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NPI Number | 1477702066
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Entity Type | Organization
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Legal Business Name | LIFESTREAM, INC
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Dates
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Enumeration Date | 09/18/2008
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Last Update Date | 02/20/2026
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Provider Practice Location Address
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Address Line | 21 FATHER DEVALLES BLVD STE 201
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City | FALL RIVER
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State | MA
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Zip | 02723-1519
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Country | US
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Telephone | 508-993-1991
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Fax | 508-674-2952
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Provider Business Mailing Address
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Address Line | PO BOX 50487
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City | NEW BEDFORD
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State | MA
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Zip | 02745-0017
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Country | US
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Telephone | 508-993-1991
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Fax | 508-985-9073
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | BONNIE MELLO
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Credential |
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Telephone | 508-993-1991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number | 1906976
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License Number State | MA
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