Healthcare Provider Details

I. General information

NPI: 1659838415
Provider Name (Legal Business Name): LIFELINE MARKETING GROUP, LLC KENNETH M FOLWELL SOLE MBR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57675 TWENTYNINE PALMS HWY SUITE 102
YUCCA VALLEY CA
92284
US

IV. Provider business mailing address

57675 TWENTYNINE PALMS HWY SUITE 102
YUCCA VALLEY CA
92284
US

V. Phone/Fax

Practice location:
  • Phone: 657-234-5433
  • Fax:
Mailing address:
  • Phone: 657-234-5433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KEN FOLWELL
Title or Position: OWNER
Credential:
Phone: 657-234-5433