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General NPI Number Information
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NPI Number | 1558743476
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Entity Type | Organization
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Legal Business Name | COMMUNITY LIFESTYLE SERVICES LLC
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Dates
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Enumeration Date | 06/27/2015
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Last Update Date | 07/10/2015
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Provider Practice Location Address
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Address Line | 2912 68TH ST
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City | LUBBOCK
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State | TX
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Zip | 79413-6312
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Country | US
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Telephone | 806-241-0998
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 529
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City | LUBBOCK
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State | TX
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Zip | 79408-0529
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Country | US
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Telephone | 806-241-0998
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Fax |
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Authorized Official
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Title or Position | OWNER/ MANAGER
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Name | MR. AUSTIN FARRELL MARTIN
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Credential |
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Telephone | 806-241-0998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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