1093849754 NPI number — LIFE ENHANCING THERAPIES

Table of content: (NPI 1093849754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093849754 NPI number — LIFE ENHANCING THERAPIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFE ENHANCING THERAPIES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
INLAND EMPIRE THERAPY PROVIDERS, INC.
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093849754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7974 HAVEN AVE STE 290
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO CUCAMONGA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91730-3061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-481-5304
Provider Business Mailing Address Fax Number:
909-481-5307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7974 HAVEN AVE STE 290
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANCHO CUCAMONGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91730-3061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-481-5304
Provider Business Practice Location Address Fax Number:
909-481-5307
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KRUPNAK
Authorized Official First Name:
PATTE
Authorized Official Middle Name:
Y
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
909-481-5304

Provider Taxonomy Codes

  • Taxonomy code: 224Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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