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NPI Code Detail

MEDICARE: LIFEWAY HEALTHCARE SERVICES INC.

MEDICARE: LIFEWAY HEALTHCARE SERVICES INC.
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
1207R00000XInternal Medicine PhysicianA73040CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21285732354OTHERCANPI

General Provider Information

NPI Number : 1629233523
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFEWAY HEALTHCARE SERVICES INC.
Provider Business Mailing Address
First Line : 10024 S VERMONT AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90044-3112
Country : US
Telephone Number : 323-242-3888
Fax Number : 323-242-1188
Provider Business Practice Location Address
First Line : 10024 S VERMONT AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90044-3112
Country : US
Telephone Number : 323-242-3888
Fax Number : 323-242-1188
Authorized Official
Title or Position : CEO
Name : DR. KINGSLEY O OFOEGBU
Credential : M.D.
Telephone Number : 323-242-3888
Provider Enumeration Date : 07/21/2008
Last Update Date : 07/21/2008

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Directions to “LIFEWAY HEALTHCARE SERVICES INC. ” Practice Location

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