Healthcare Provider Details

I. General information

NPI: 1528194339
Provider Name (Legal Business Name): LIFELONG MEDICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 MACARTHUR BLVD SUITE 14A
OAKLAND CA
94605-5298
US

IV. Provider business mailing address

2344 6TH ST
BERKELEY CA
94710-2412
US

V. Phone/Fax

Practice location:
  • Phone: 510-563-4390
  • Fax:
Mailing address:
  • Phone: 510-981-4123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

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