Lifestream Behavioral Center Inc
Organization Active NPI Psychiatric Hospital · Leesburg, FL
NPI 1902802002 · NPPES record last updated Jul 18, 2012
Key facts
- NPI
- 1902802002
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatric Hospital 283Q00000X
- License
- 4075 (FL)
- Legal business name
- LIFESTREAM BEHAVIORAL CENTER INC
- Practice address
- 2020 Talley Rd
Leesburg, FL 34748-3426 - Phone
- (352) 315-7800
- Fax
- (352) 315-6595
- NPI assigned
- Jun 23, 2005
- Organization subpart
- No
Authorized official
- Name
- Ms. Carol E Dozier, CPA
- Title
- Cfo
- Phone
- (352) 315-7532
Other NPIs on the same Medicare enrollment 1
Subparts reporting this organization as parent 1
Practitioners 118
-
Julie Avescat, APRN
-
Chantal P Baptiste, APRN
-
Lailatullah Burgos, APRN, NP-C
-
Julie M Conrad, ARNP
-
Abid Darr, MD
-
Larhonda Marie Enslow, APRN
-
Donald A Freeman, ARNP
-
Latangra M McIntosh, APRN
-
Terri Ann Saunders, APRN
-
Chrystal Shirley, APRN
-
Thomas Valente, MD
-
Natasha Wren Kerrick, PMHNP
-
Adriana Bentum-Tilus, APRN
-
Brad Broyles, MD
-
Ann Marie Alicia Burke, APRN
-
David Abolarin Dada, M.D.
-
Andrea Loretta Ellis, FNP
-
Sherri Ann Ferguson, ARNP
-
Amanda Gaskin, ARNP
Medicare Care Compare: Hospital
- Listed as
- Lifestream Behavioral Center
- Type
- Psychiatric
- Ownership
- Proprietary
- Medicare certification status
- Active
- Emergency services
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in FL
Hospital certification: CCN 104018
- Legal name
- LIFESTREAM BEHAVIORAL CENTER INC
- Certification status
- Active
- Provider type (POS)
- Hospital – Psychiatric
- Participating since
- Oct 1, 1974
- Last certification
- Apr 8, 2022
- Beds
- 46
- Ownership / control type
- Private (for profit)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 12, 1971 in FL
- Enrollment address
- 2020 Tally Rd
Leesburg, FL 34748-3426 - Hospital subgroups
- Psychiatric
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Rick Hankey |
Corporate Director |
Jul 1, 2023 | |
| W-2 Managing Employee | Jul 1, 2023 | ||
| Timothy Morris |
Corporate Officer |
Oct 27, 2009 | |
| Lifestream Behavioral Center Inc |
Operational/Managerial Control | Jun 15, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040618000512 | FL | Part B Supplier - Clinic/Group Practice | 7012992720 |
Receives reassigned benefits from 39 practitioners 1 other NPI on this enrollment Practice locations: Brooksville, FL; Bushnell, FL; Clermont, FL; Eustis, FL; Umatilla, FL; Sumterville, FL; Ocoee, FL; Ocala, FL… |
| O20100913001132 | FL | Part a Provider - Hospital | 7012992720 | Practice locations: Leesburg, FL |
National Provider Directory
Locations
2120 N Don Wickham Dr
Clermont, FL 34711
Phone (352) 315-7501
215 N 3rd St
Leesburg, FL 34748
Phone (352) 315-7900
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
- HealthSun Health Plans Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist |
103TC2200X | |||
| Psychiatry Physician |
2084P0800X | |||
| Case Management Agency | 251B00000X | |||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | |||
| Psychiatric Hospital | 283Q00000X | 4075 | FL | Yes |
| Psychiatric Residential Treatment Facility | 323P00000X |
Addresses
Primary practice location
2020 Talley Rd
Leesburg, FL 34748-3426
Mailing address
PO Box 491000
Leesburg, FL 34749-1000
Phone (352) 315-7500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 060334100 | Medicaid | FL | |
| 151443 | Other | FL | WELLCARE PROVIDER # |
| 060334108 | Medicaid | FL | |
| 060334102 | Medicaid | FL | |
| 98270 | Other | FL | BCBS OUTPATIENT NUMBER |
| E-83 | Other | FL | BCBS INPATIENT NUMBER |
| 024576301 | Medicaid | FL | |
| 060334105 | Medicaid | FL | |
| 360181100 | Medicaid | FL |
Other providers in Leesburg, FL
- Mary Beth Lewis-Boardman
- LHCG CLV, LLC
- David Richard Lichtinger
- Life-Line Medical Transportation Inc.
- Lifestream Behavioral Center Inc
- Limitless Care
- Centcha Limprevil
- Lincare Inc.
- Lindsay Campbell
- Sauw Liong
All providers in Leesburg, FL · Psychiatric Hospital in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.