Provider Demographics
NPI:1518183318
Name:LIFESTREAM SERVICES, INC
Entity type:Organization
Organization Name:LIFESTREAM SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-759-1121
Mailing Address - Street 1:1701 S PILGRIM BLVD
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47396-9801
Mailing Address - Country:US
Mailing Address - Phone:765-759-1211
Mailing Address - Fax:765-759-0060
Practice Address - Street 1:1701 S PILGRIM BLVD
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:IN
Practice Address - Zip Code:47396-9280
Practice Address - Country:US
Practice Address - Phone:765-759-1121
Practice Address - Fax:765-759-0060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100107940AMedicaid