NPIMap

Organization Active NPI

Lifestream Behavioral Center Inc

  • Psychiatric Hospital
  • Leesburg, FL
National Provider Identifier
1902802002
Registry record updated Jul 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
4075 Issued in 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
Last updated
Jul 18, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2012

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

Authorized official

Name
Ms. Carol E Dozier, CPA
Title
Cfo
Phone
(352) 315-7532

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
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 Primary
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 9

IdentifierTypeStateIssuer
360181100MedicaidFL
98270OtherFLBCBS OUTPATIENT NUMBER
E-83OtherFLBCBS INPATIENT NUMBER
024576301MedicaidFL
060334105MedicaidFL
151443OtherFLWELLCARE PROVIDER #
060334100MedicaidFL
060334102MedicaidFL
060334108MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902802002. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Mar 12, 1971 in FL
Enrollment address
2020 Tally Rd
Leesburg, FL 34748-3426
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Lifestream Behavioral CenterCCN 104018 · All quality measures
Type
Psychiatric
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory

Locations

2120 N Don Wickham Dr
Clermont, FL 34711
Phone (352) 315-7501

2140 N Don Wickham Dr
Clermont, FL 34711
Phone (352) 394-5322

206 S Apopka Ave
Inverness, FL 34452
Phone (352) 341-4160

2018 Tally Rd
Leesburg, FL 34748
Phone (352) 315-7400

2020 Tally Rd
Leesburg, FL 34748
Phone (352) 315-7800

6215 Holly St
Mount Dora, FL 32757
Phone (352) 383-9242

Networks

  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Máximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
  • HealthSun Health Plans Network
  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Rick Hankey Individual Corporate DirectorCeo Jul 1, 2023
W-2 Managing Employee Jul 1, 2023
Timothy Morris Individual Corporate OfficerBoard Chairman Oct 27, 2009
Lifestream Behavioral Center Inc Organization, Leesburg, FL Non-profit Operational/Managerial Control Jun 15, 2019

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 119

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 119

NPI Registry JSON

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

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342569600000",
    "number": "1902802002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 491000",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347491000",
            "telephone_number": "352-315-7500",
            "fax_number": "352-360-6595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 TALLEY RD",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347483426",
            "telephone_number": "352-315-7800",
            "fax_number": "352-315-6595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESTREAM BEHAVIORAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-23",
        "last_updated": "2012-07-18",
        "status": "A",
        "authorized_official_last_name": "DOZIER",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "352-315-7532",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "FL",
            "license": "4075",
            "primary": true
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "360181100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OUTPATIENT NUMBER",
            "identifier": "98270",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS INPATIENT NUMBER",
            "identifier": "E-83",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "024576301",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060334105",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE PROVIDER #",
            "identifier": "151443",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060334100",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060334102",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060334108",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Leesburg, FL

Sources for this page

Verify at the official NPI Registry.