Provider Demographics
NPI:1124101043
Name:LIFESTYLES UNLIMITED, INC.
Entity type:Organization
Organization Name:LIFESTYLES UNLIMITED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:BLAINE
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:620-232-5680
Mailing Address - Street 1:P.O. BOX 716
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762
Mailing Address - Country:US
Mailing Address - Phone:620-232-5680
Mailing Address - Fax:620-232-5765
Practice Address - Street 1:107 NORTH PINE SUITE 2
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762
Practice Address - Country:US
Practice Address - Phone:620-232-5680
Practice Address - Fax:620-232-5765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS3960700001Medicare ID - Type Unspecified