LIFESTREAM BEHAVIORAL CENTER INC (NPI# 1902802002) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902802002 |
| Entity Type | Organization |
| Organization Name | LIFESTREAM BEHAVIORAL CENTER INC |
| Practice Address |
2020 Talley Rd Leesburg FL 34748-3426 |
| Mailing Address |
Po Box 491000 Leesburg FL 34749-1000 |
| Practice Telephone | 3523157800 |
| Practice Fax Number | 3523156595 |
| Mailing Telephone | 3523157500 |
| Mailing Fax Number | 3523606595 |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2012-07-18 |
| Authorized Official Name | MS. CAROL E DOZIER (CFO) |
| Authorized Official Telephone | 3523157532 |
| Authorized Official Credential | CPA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 323P00000X | Psychiatric Residential Treatment Facility | Residential Treatment Facilities | ||
| N | 251B00000X | Case Management | Agencies | ||
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians | ||
| N | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
Behavioral Health & Social Service Providers | ||
| N | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities | ||
| Y | 283Q00000X | Psychiatric Hospital | 4075 | FL | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 024576301 | 05 | |
| FL | 360181100 | 05 | |
| FL | 060334100 | 05 | |
| FL | 060334105 | 05 | |
| FL | 060334102 | 05 | |
| FL | WELLCARE PROVIDER # | 151443 | 01 |
| FL | 060334108 | 05 | |
| FL | BCBS OUTPATIENT NUMBER | 98270 | 01 |
| FL | BCBS INPATIENT NUMBER | E-83 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659613776 | Lifestream Behavioral Center Inc | Clinic/Center | 215 N 3rd St, Leesburg, FL 34748-5105 | 2013-03-27 |
| Street Address |
2020 TALLEY RD |
| City | LEESBURG |
| State | FL |
| Zip Code | 34748-3426 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013421569 | Saad Siddiqui | Physician Assistant | 2020 Talley Rd, Leesburg, FL 34748-3426 | 2017-11-20 |
| 1801310602 | Lindsey Pollen | Counselor | 2020 Talley Rd, Leesburg, FL 34748-3426 | 2017-08-02 |
| 1619409463 | Julia M Palomino | Social Worker | 2020 Talley Rd, Leesburg, FL 34748-3426 | 2017-03-31 |
| 1285175059 | Olga Rodriguez-burgos | Counselor | 2020 Talley Rd, Leesburg, FL 34748-3426 | 2017-03-14 |
| 1093258642 | Nageley Michel | Nurse Practitioner | 2020 Talley Rd, Leesburg, FL 34748-3426 | 2016-11-30 |
| 1518310630 | Michelle Joop | Social Worker | 2020 Talley Rd, Leesburg, FL 34748-3426 | 2016-07-14 |
| 1871940783 | Abid Darr | Psychiatry & Neurology | 2020 Talley Rd, Leesburg, FL 34748-3426 | 2016-05-20 |
| 1063871572 | Steven Dolliver | Counselor | 2020 Talley Rd, Leesburg, FL 34748-3426 | 2016-02-12 |
| 1518326180 | Darla Peters | Counselor | 2020 Talley Rd, Leesburg, FL 34748-3426 | 2016-02-11 |
| 1972982155 | Ivelisse Correa | Counselor | 2020 Talley Rd, Leesburg, FL 34748-3426 | 2015-05-21 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437610243 | Ashley Shamsa Martin | Behavior Technician | 292 Bent Oak Ct, Leesburg, FL 34748 | 2019-03-26 |
| 1891278875 | Luis O Aponte Mendoza | Physician Assistant | 704 Doctors Ct., Suite 101, Leesburg, FL 34748 | 2018-09-14 |
| 1881197903 | Physician Associates LLC | Internal Medicine | 22316 Us Highway 27, Leesburg, FL 34748 | 2018-03-15 |
| 1184136145 | Infinite Support Services LLC | In Home Supportive Care | 129 Grove Ridge Circle, 104, Leesburg, FL 34748 | 2017-10-31 |
| 1619403037 | Massage and Wellness Care | Health Maintenance Organization | 1218 W. Dixie Ave, Suite A, Leesburg, FL 34748 | 2017-05-04 |
| 1497202675 | Prime Radiology of Leesburg Inc | Radiology | 600 N W Blvd, Suite E, Leesburg, FL 34748 | 2016-09-06 |
| 1023480332 | Juanita Elizabeth Simpson | Contractor | 1911 Harcourt Drive, Leesburg, FL 34748 | 2015-10-26 |
| 1467835900 | Serenity Choice Place, LLC | Community/Behavioral Health | 721 Balmoral Circle, Leesburg, FL 34748 | 2015-07-01 |
| 1356738397 | Touching Heart's Group Homes, LLC | Community/Behavioral Health | 31809 Sunpark Cir, Leesburg, FL 34748 | 2015-04-16 |
| 1386035269 | Adventist Health System/sunbelt, Inc. | Clinic/Center | 1103 N 14th Street, Leesburg, FL 34748 | 2015-02-12 |
| Find all providers in zip 34748 | ||||
| Taxonomy Code | 283Q00000X |
| Grouping | Hospitals |
| Classification | Psychiatric Hospital |
| An organization including a physical plant and personnel that provides multidisciplinary diagnostic and treatment mental health services to patients requiring the safety, security, and shelter of the inpatient or partial hospitalization settings. |
| Notes: Source: Expanded from Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
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| 1740614734 | Daniel Leighton Hollar | Psychiatric Hospital | 2387 Parrot Ln, Tallahassee, FL 32303-8333 | 2013-08-26 |
| 1578814265 | Jackson South Community Hospital | Psychiatric Hospital | 9333 Sw 152 St, Miami, FL 33156 | 2012-09-21 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.