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General NPI Number Information
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NPI Number | 1932511458
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Entity Type | Organization
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Legal Business Name | LIFE STYLES SUPPORTS, INC.
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Dates
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Enumeration Date | 06/02/2014
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Last Update Date | 06/16/2020
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Provider Practice Location Address
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Address Line | 116 DENSTEN RD
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City | SEWELL
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State | NJ
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Zip | 08080-1890
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Country | US
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Telephone | 856-589-5640
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Fax | 856-589-1516
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Provider Business Mailing Address
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Address Line | PO BOX 594
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City | SEWELL
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State | NJ
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Zip | 08080-0594
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Country | US
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Telephone | 856-589-5640
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Fax | 856-589-1516
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. DIANE ESTELLE HERNANDEZ
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Credential |
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Telephone | 856-589-5640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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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 | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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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 | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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