Healthcare Provider Details

I. General information

NPI: 1528754355
Provider Name (Legal Business Name): LIFECOURSECONNECT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2731 DUFFERIN ST.
TORONTO ONTARIO
M6B 3R5
CA

IV. Provider business mailing address

2731 DUFFERIN ST.
TORONTO ONTARIO
M6B 3R5
CA

V. Phone/Fax

Practice location:
  • Phone: 416-738-8388
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. SALVATORE MARRELLO
Title or Position: PRINCIPAL
Credential:
Phone: 416-884-1472