Provider Demographics
NPI:1104895820
Name:LIFE STYLES INC.
Entity type:Organization
Organization Name:LIFE STYLES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-521-3581
Mailing Address - Street 1:2471 W SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-1140
Mailing Address - Country:US
Mailing Address - Phone:479-521-3581
Mailing Address - Fax:479-695-1778
Practice Address - Street 1:2471 W SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-1140
Practice Address - Country:US
Practice Address - Phone:479-521-3581
Practice Address - Fax:479-695-1778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR133281724Medicaid
AR160536771Medicaid
AR118466715Medicaid
AR129639774Medicaid
AR125864767Medicaid
AR126145775Medicaid
AR121248732Medicaid