Healthcare Provider Details

I. General information

NPI: 1346068616
Provider Name (Legal Business Name): LIFELINE TREATMENT CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6851 CANBY AVE STE 102
RESEDA CA
91335-4307
US

IV. Provider business mailing address

6851 CANBY AVE STE 102
RESEDA CA
91335-4307
US

V. Phone/Fax

Practice location:
  • Phone: 323-356-4157
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARINA LEDVINA
Title or Position: CEO
Credential:
Phone: 323-356-4157