Organization
LIFELINE CONNECTIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KINH REYNOLDS (CFO)
(360) 397-8246
Entity
Organization
Contact information
Practice address
1601 E FOURTH PLAIN BLVD, BUILDING 17, VANCOUVER, WA 98661-3753
(360) 397-8246
Mailing address
PO BOX 1678, VANCOUVER, WA 98668-1678
(360) 397-8246
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
RTF - 1075
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1990126
—
WA
Enumeration date
04/24/2007
Last updated
03/01/2023
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