Organization
LIFELINE MARKETING GROUP, LLC KENNETH M FOLWELL SOLE MBR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEN FOLWELL (OWNER)
(657) 234-5433
Entity
Organization
Contact information
Practice address
57675 TWENTYNINE PALMS HWY, SUITE 102, YUCCA VALLEY, CA 92284
(657) 234-5433
Mailing address
57675 TWENTYNINE PALMS HWY, SUITE 102, YUCCA VALLEY, CA 92284
(657) 234-5433
Taxonomy
Speciality
Code
Description
License number
State
170300000X
Genetic Counselor (M.S.)
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528436367
—
CA
01
—
332B00000X
332B00000X
AZ
Enumeration date
02/27/2019
Last updated
06/23/2022
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