Provider Demographics
NPI:1174315519
Name:MAINSTREAM LIFESTYLES, INC.
Entity type:Organization
Organization Name:MAINSTREAM LIFESTYLES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VON DEAUXPLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-333-4893
Mailing Address - Street 1:1887 BUSINESS CENTER DR # 6A
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3463
Mailing Address - Country:US
Mailing Address - Phone:951-333-4893
Mailing Address - Fax:
Practice Address - Street 1:11206 RAYMOND RD
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-6589
Practice Address - Country:US
Practice Address - Phone:951-333-4893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child