Provider Demographics
NPI:1386794527
Name:LIFESKILLS LLC
Entity type:Organization
Organization Name:LIFESKILLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:CLIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:OTL
Authorized Official - Phone:907-350-3840
Mailing Address - Street 1:200 W 34TH AVE # 427
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3969
Mailing Address - Country:US
Mailing Address - Phone:907-947-3820
Mailing Address - Fax:877-409-9161
Practice Address - Street 1:505 W NORTHERN LIGHTS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2552
Practice Address - Country:US
Practice Address - Phone:907-205-4366
Practice Address - Fax:877-409-9161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKSTATEOF ALASKA#479225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK0T8794Medicaid