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LIFETIME CHANGES BEHAVIOR SERVICES LLC

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Company Details

Name: LIFETIME CHANGES BEHAVIOR SERVICES LLC
Jurisdiction: New York
Legal type: DOMESTIC LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 26 Aug 2020 (5 years ago)
Entity Number: 5821279
ZIP code: 10310
County: Richmond
Place of Formation: New York
Address: 683 HENDERSON AVE. SUITE A, STATEN ISLAND, NY, United States, 10310

DOS Process Agent

Name Role Address
THE LLC DOS Process Agent 683 HENDERSON AVE. SUITE A, STATEN ISLAND, NY, United States, 10310

National Provider Identifier

NPI Number:
1578182770
Certification Date:
2021-05-25

Authorized Person:

Name:
MS. DANA VAN DYKE
Role:
OWNER/PROGRAM DIRECTOR
Phone:

Taxonomy:

Selected Taxonomy:
251B00000X - Case Management Agency
Is Primary:
No
Selected Taxonomy:
251C00000X - Developmentally Disabled Services Day Training Agency
Is Primary:
No
Selected Taxonomy:
251S00000X - Community/Behavioral Health Agency
Is Primary:
No
Selected Taxonomy:
261QC1500X - Community Health Clinic/Center
Is Primary:
No
Selected Taxonomy:
261QD1600X - Developmental Disabilities Clinic/Center
Is Primary:
No

Contacts:

Fax:
7187322628

History

Start date End date Type Value
2020-08-26 2021-05-28 Address 20 COWEN PLACE, STATEN ISLAND, NY, 10303, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
210528000254 2021-05-28 CERTIFICATE OF CHANGE 2021-05-28
200826010030 2020-08-26 ARTICLES OF ORGANIZATION 2020-08-26

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Date of last update: 22 Mar 2025

Sources: New York Secretary of State