Healthcare Provider Details

I. General information

NPI: 1568598829
Provider Name (Legal Business Name): LIFELONG MEDICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 16TH ST
OAKLAND CA
94612-1205
US

IV. Provider business mailing address

616 16TH ST
OAKLAND CA
94612-1205
US

V. Phone/Fax

Practice location:
  • Phone: 510-451-4270
  • Fax:
Mailing address:
  • Phone: 510-451-4270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: MARTY LYNCH
Title or Position: CEO
Credential:
Phone: 510-981-4123