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General NPI Number Information
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NPI Number | 1942629746
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Entity Type | Organization
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Legal Business Name | LIFE LINE COMMUNITY HEALTHCARE - KANSAS, PA
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Dates
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Enumeration Date | 04/09/2014
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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 | 866-964-3286
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Fax | 866-345-6156
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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 | 866-964-3286
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Fax | 866-345-6156
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDREW J MANGANARO
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Credential | M.D.
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Telephone | 866-964-3286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SC1501X
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Taxonomy Name | Community Health/Public Health Clinical Nurse Specialist
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License Number | 04-31805
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License Number State | KS
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