Organization
LIFESCAPE COMMUNITY SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CAROL GREEN (EXECUTIVE DIRECTOR)
(815) 963-1609
Entity
Organization
Contact information
Practice address
705 KILBURN AVE, ROCKFORD, IL 61101-6550
(815) 963-1609
(815) 963-1627
Mailing address
705 KILBURN AVE, ROCKFORD, IL 61101-6550
(815) 963-1609
(815) 963-1627
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Enumeration date
01/30/2012
Last updated
01/30/2012
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