Healthcare Provider Details

I. General information

NPI: 1194371674
Provider Name (Legal Business Name): ALL.WALKS.THRU.LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4138 VAHAN CT
LANCASTER CA
93536-6838
US

IV. Provider business mailing address

4138 VAHAN CT
LANCASTER CA
93536-6838
US

V. Phone/Fax

Practice location:
  • Phone: 888-741-6180
  • Fax: 877-561-6971
Mailing address:
  • Phone: 888-741-6180
  • Fax: 877-561-6971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: PAULSHAUNA J FUGETT
Title or Position: MEMBER
Credential:
Phone: 909-619-9321