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General NPI Number Information
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NPI Number | 1396257101
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Entity Type | Organization
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Legal Business Name | LIFELINE CONNECTIONS HEALTH HOMES
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Dates
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Enumeration Date | 11/02/2017
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 1601 E FOURTH PLAIN BLVD BLDG 17 SUITE A212
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City | VANCOUVER
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State | WA
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Zip | 98661
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Country | US
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Telephone | 360-397-8246
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Fax | 360-397-8250
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Provider Business Mailing Address
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Address Line | PO BOX 1678
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City | VANCOUVER
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State | WA
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Zip | 98668-1678
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Country | US
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Telephone | 360-397-8246
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Fax | 360-397-8250
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Authorized Official
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Title or Position | CFO
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Name | KINH REYNOLDS
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Credential |
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Telephone | 360-397-8246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | CO.60429455
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License Number State | WA
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