Organization
LIFESTYLE BOARD AND CARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM GALLIOS (OFFICE MANAGER)
(702) 290-3235
Entity
Organization
Contact information
Practice address
149 E 235TH ST, CARSON, CA 90745-5318
(310) 834-9325
Mailing address
149 E 235TH ST, CARSON, CA 90745-5318
(310) 834-9325
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
198320092
STATE LICENSE
CA
Enumeration date
05/25/2022
Last updated
05/25/2022
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