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General NPI Number Information
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NPI Number | 1689892473
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Entity Type | Organization
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Legal Business Name | LIFELINE CONNECTIONS
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Dates
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Enumeration Date | 04/24/2007
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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 BUILDING 17
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City | VANCOUVER
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State | WA
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Zip | 98661-3753
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Country | US
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Telephone | 360-397-8246
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Fax |
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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 |
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | RTF - 1075
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License Number State | WA
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