MEDICARE: LIFESTYLES FOR THE DISABLED, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043616212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESTYLES FOR THE DISABLED, INC.

Provider Business Mailing Address
First Line	:	930 WILLOWBROOK RD
Second Line	:	BUILDING 12G
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-4209
Country	:	US
Telephone Number	:	718-983-5351
Fax Number	:	718-983-5383

Provider Business Practice Location Address
First Line	:	930 WILLOWBROOK RD
Second Line	:	BUILDING 12G
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-4209
Country	:	US
Telephone Number	:	718-983-5351
Fax Number	:	718-983-5383

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MR. SCOTT RICHARD SALINARDI
Credential	:
Telephone Number	:	718-983-5351

Provider Enumeration Date	:	11/14/2014
Last Update Date	:	11/14/2014

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