1033519657 NPI number — LIFE LINE COMMUNITY HEALTHCARE CALIFORNIA

Table of content: (NPI 1033519657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033519657 NPI number — LIFE LINE COMMUNITY HEALTHCARE CALIFORNIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFE LINE COMMUNITY HEALTHCARE CALIFORNIA
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:
Provider Other Organization Name Type Code:
6
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:
1033519657
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6111 OAK TREE BLVD STE 301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDEPENDENCE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44131-2585
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-388-3781
Provider Business Mailing Address Fax Number:
866-345-6156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25350 MAGIC MOUNTAIN PKWY STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALENCIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91355-1356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-388-3781
Provider Business Practice Location Address Fax Number:
866-345-6156
Provider Enumeration Date:
09/02/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MANGANARO
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
888-388-3781

Provider Taxonomy Codes

  • Taxonomy code: 2083P0901X , with the licence number:  33259 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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