Provider Demographics
NPI:1962702449
Name:LIFEWORKS-ACS, INC.
Entity type:Organization
Organization Name:LIFEWORKS-ACS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MENDEL
Authorized Official - Middle Name:ALIDIO
Authorized Official - Last Name:UYCHUTIN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:209-462-1598
Mailing Address - Street 1:1755 W. HAMMER LANE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-2900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1755 W. HAMMER LANE
Practice Address - Street 2:SUITE# 1
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-2900
Practice Address - Country:US
Practice Address - Phone:209-462-1598
Practice Address - Fax:209-942-0294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4891225X00000X
CA2330225X00000X
CA16503235Z00000X
CA13292235Z00000X
CA13231235Z00000X
CA9927235Z00000X
CA17406235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty