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General NPI Number Information
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NPI Number | 1093118853
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Entity Type | Organization
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Legal Business Name | LIFE LINE COMMUNITY HEALTHCARE NEW JERSEY, LLC
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Dates
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Enumeration Date | 10/07/2014
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 6111 OAK TREE BLVD STE 301
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City | INDEPENDENCE
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State | OH
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Zip | 44131-2585
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Country | US
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Telephone | 216-581-6556
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Fax |
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Provider Business Mailing Address
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Address Line | 6111 OAK TREE BLVD STE 301
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City | INDEPENDENCE
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State | OH
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Zip | 44131-2585
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Country | US
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Telephone | 216-581-6556
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | ANDREW MANGANARO
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Credential | MD
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Telephone | 866-964-3290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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