Lifestyle Board and Care, Inc

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

LIFESTYLE BOARD AND CARE, INC

Practice address

149 E 235TH St
Carson, CA 90745-5318

Phone

(310) 834-9325

NPI assigned

May 25, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. William Gallios

Title

Office Manager

Phone

(702) 290-3235

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1653436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653436800000",
    "number": "1053059378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "149 E 235TH ST",
            "city": "CARSON",
            "state": "CA",
            "postal_code": "907455318",
            "telephone_number": "310-834-9325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 E 235TH ST",
            "city": "CARSON",
            "state": "CA",
            "postal_code": "907455318",
            "telephone_number": "310-834-9325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESTYLE BOARD AND CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-25",
        "last_updated": "2022-05-25",
        "certification_date": "2022-05-25",
        "status": "A",
        "authorized_official_last_name": "GALLIOS",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "702-290-3235",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "198320092",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "eFax",
            "affiliation": "N",
            "endpointDescription": "eFax",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "149 E 235th St",
            "city": "Carson",
            "state": "CA",
            "country_code": "US",
            "postal_code": "907455318",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Adult Care Home Facility in Carson, CA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.