Healthcare Provider Details

I. General information

NPI: 1356616627
Provider Name (Legal Business Name): LIFELUNG, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 S GLADYS AVE
SAN GABRIEL CA
91776-3132
US

IV. Provider business mailing address

1231 S GLADYS AVE
SAN GABRIEL CA
91776-3132
US

V. Phone/Fax

Practice location:
  • Phone: 626-614-9581
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: MISS ANNETTE PALAZUELOS
Title or Position: PRESIDENT
Credential:
Phone: 626-614-9581