Organization
LIFESKILLS
Active
Other names
Lifeskills Children
Organization subpart
No
Provider details
NPI number
Authorized official
JOE DAN BEAVERS (CEO)
(270) 901-5000
Entity
Organization
Contact information
Practice address
380 SUWANNEE TRAIL ST, BOWLING GREEN, KY 42103-7956
(270) 901-5000
(270) 842-5268
Mailing address
380 SUWANNEE TRAIL ST, BOWLING GREEN, KY 42103-7956
(270) 901-5000
(270) 842-5268
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
800004
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
28004018
—
KY
Enumeration date
10/22/2007
Last updated
12/12/2019
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