Provider Demographics
NPI:1487055919
Name:LIFEWORKS SUBSTANCE ABUSE SERVICES LLC
Entity type:Organization
Organization Name:LIFEWORKS SUBSTANCE ABUSE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RHOADIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LADD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-979-5023
Mailing Address - Street 1:4678 TAMIAMI TRL
Mailing Address - Street 2:#105
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-2900
Mailing Address - Country:US
Mailing Address - Phone:941-979-5023
Mailing Address - Fax:941-979-5064
Practice Address - Street 1:4678 TAMIAMI TRL
Practice Address - Street 2:#105
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-2900
Practice Address - Country:US
Practice Address - Phone:941-979-5023
Practice Address - Fax:941-979-5064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8565101YM0800X
324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH8565OtherSTATE OF FLORIDA