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General NPI Number Information
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NPI Number | 1801206446
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Entity Type | Organization
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Legal Business Name | LIFELONG MEDICAL
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Dates
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Enumeration Date | 05/05/2014
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Last Update Date | 05/05/2014
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Provider Practice Location Address
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Address Line | 1415 HARRISON ST 201
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City | OAKLAND
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State | CA
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Zip | 94612-3922
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Country | US
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Telephone | 510-238-9380
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Fax |
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Provider Business Mailing Address
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Address Line | 1415 HARRISON ST 201
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City | OAKLAND
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State | CA
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Zip | 94612-3922
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Country | US
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Telephone | 510-238-9380
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Fax |
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Authorized Official
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Title or Position | PSYCHOSOCIAL SERVICES DIRECTOR
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Name | BRENDA GOLDSTEIN
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Credential |
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Telephone | 510-981-4136
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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 | FHC70474G
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License Number State | CA
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