1417214727 NPI number — FORT HELP, LLC

Table of content: (NPI 1417214727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417214727 NPI number — FORT HELP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FORT HELP, LLC
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:
LIFELINE TREATMENT SERVICES, INC.
Provider Other Organization Name Type Code:
3
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:
1417214727
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26460 SUMMIT CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA CLARITA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91350-2991
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-254-6630
Provider Business Mailing Address Fax Number:
661-254-6644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9442 INTERNATIONAL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94603-1444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-777-8448
Provider Business Practice Location Address Fax Number:
510-727-9761
Provider Enumeration Date:
04/12/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SHARMA
Authorized Official First Name:
STAN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
661-254-6630

Provider Taxonomy Codes

  • Taxonomy code: 261QM2800X , with the licence number:  01-95 , 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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