MEDICARE: EDCA LIFESKILL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1548399694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDCA LIFESKILL

Provider Business Mailing Address
First Line	:	893 SPRING ST
Second Line	:
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-4437
Country	:	US
Telephone Number	:	530-622-8193
Fax Number	:	530-622-4017

Provider Business Practice Location Address
First Line	:	893 SPRING ST
Second Line	:
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-4437
Country	:	US
Telephone Number	:	530-622-8193
Fax Number	:	530-622-4017

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. DAVID JOHN DEL RIO
Credential	:
Telephone Number	:	530-622-8193

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	10/31/2011

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Directions to “EDCA LIFESKILL ” Practice Location

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