Organization
LIFELONG MEDICAL
Active
Organization
LIFELONG MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA GOLDSTEIN (PSYCHOSOCIAL SERVICES DIRECTOR)
(510) 981-4136
Entity
Organization
Contact information
Practice address
1415 HARRISON ST, 201, OAKLAND, CA 94612-3922
(510) 238-9380
Mailing address
1415 HARRISON ST, 201, OAKLAND, CA 94612-3922
(510) 238-9380
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
FHC70474G
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FHC70474G
—
CA
Enumeration date
05/05/2014
Last updated
05/05/2014
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