Healthcare Provider Details

I. General information

NPI: 1801718309
Provider Name (Legal Business Name): LTID HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13542 SECOND STREET REHAB ROOM
YUCAIPA CA
92399-5396
US

IV. Provider business mailing address

5545 BLUE RIDGE DR
YORBA LINDA CA
92887-4251
US

V. Phone/Fax

Practice location:
  • Phone: 909-904-9048
  • Fax: 323-900-0285
Mailing address:
  • Phone: 909-904-9048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225B00000X
TaxonomyPulmonary Function Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2279P1005X
TaxonomyPulmonary Rehabilitation Registered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name: EVANGELINE R POWELL
Title or Position: MANAGING MEMBER
Credential: RN
Phone: 909-904-9048