LIFELONG MEDICAL CARE (NPI# 1407973043) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407973043 |
| Entity Type | Organization |
| Organization Name | LIFELONG MEDICAL CARE |
| Other Organization Name | LIFELONG BROOKSIDE COMMUNITY HEALTH CENTER RICHMOND |
| Practice Address |
1030 Nevin Ave Richmond CA 94801-3122 |
| Mailing Address |
Po Box 11247 Berkeley CA 94712-2247 |
| Practice Telephone | 5102155001 |
| Practice Fax Number | 5102151115 |
| Mailing Telephone | 5109814100 |
| Mailing Fax Number | 5109814193 |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2012-06-08 |
| Authorized Official Name | MARTY LYNCH (CEO) |
| Authorized Official Telephone | 5109814100 |
| Is Organization Subpart | Y |
| Parent Organization Name | LIFELONG MEDICAL CARE |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QC1500X |
Clinic/Center Specialization: Community Health |
550000122 | CA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | FHC71108F | 05 |
| Other Name | Type Code |
|---|---|
| LifeLong Brookside Community Health Center Richmond | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003289463 | Lifelong Medical Care | Family Medicine | 2 California St, Rodeo, CA 94572-1311 | 2015-11-06 |
| 1871919233 | Lifelong Medical Care | Case Management | 1415 Harrison St, Oakland, CA 94612-3922 | 2014-03-10 |
| 1598181950 | Lifelong Medical Care | Case Management | 1424 Jefferson St, Oakland, CA 94612-1972 | 2014-03-10 |
| 1871918524 | Lifelong Medical Care | Case Management | 3501 San Pablo Ave, Oakland, CA 94608-4255 | 2014-03-04 |
| 1154327138 | Lifelong Medical Care | Family Medicine | 10700 Macarthur Blvd, Ste 14b, Oakland, CA 94605-5260 | 2005-06-23 |
| 1013913300 | Lifelong Medical Care | Dentist | 1860 Alcatraz Ave, Berkeley, CA 94703-2715 | 2005-06-22 |
| 1720084163 | Lifelong Medical Care | Family Medicine | 2031 6th St, Berkeley, CA 94710-2006 | 2005-06-21 |
| 1689670002 | Lifelong Medical Care | Family Medicine | 3260 Sacramento St, Berkeley, CA 94702-2739 | 2005-06-21 |
| 1952943979 | Lifelong Medical Care | Non-Pharmacy Dispensing Site | 616 16th St, Oakland, CA 94612-1205 | 2019-10-10 |
| 1760024780 | Lifelong Medical Care | Non-Pharmacy Dispensing Site | 2023 Vale Rd Ste 107, San Pablo, CA 94806-3891 | 2019-10-10 |
| Street Address |
1030 NEVIN AVE |
| City | RICHMOND |
| State | CA |
| Zip Code | 94801-3122 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770517666 | George M Jackson | Emergency Medicine | 1030 Nevin Ave, Richmond, CA 94801-3122 | 2006-07-10 |
| 1992340830 | Christine Tarrant | Social Worker | 1030 Nevin Ave, Richmond, CA 94801-3122 | 2019-11-14 |
| 1679123616 | Shevaun M Lewallen | Nurse Practitioner | 1030 Nevin Ave, Richmond, CA 94801-3122 | 2019-09-11 |
| 1225418544 | Lifelong Medical Care | Social Worker | 1030 Nevin Ave, Richmond, CA 94801-3122 | 2015-06-02 |
| 1659682854 | Bamidele Ayoola Olatunbosun | Family Medicine | 1030 Nevin Ave, Richmond, CA 94801-3122 | 2010-06-23 |
| 1417147422 | Teshina Nicole Wilson | Family Medicine | 1030 Nevin Ave, Richmond, CA 94801-3122 | 2007-07-26 |
| 1306943451 | Barbara Ann Williamson | Registered Nurse | 1030 Nevin Ave, Richmond, CA 94801-3122 | 2006-09-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154815082 | Denise Carey | Social Worker | 900 Nevin, Richmond, CA 94801 | 2018-06-14 |
| 1063909414 | Sunjae Jung | Dentist | 265 16th St, Richmond, Richmond, CA 94801 | 2018-04-20 |
| 1780100479 | Daniel Chen | Dentist | 520 Seacliff Pl, Richmond, CA 94801 | 2017-08-15 |
| 1790043347 | Kanwal Ambar Merchant | Pediatrics | 150 Harbor Way, Richmond, CA 94801 | 2012-05-01 |
| 1114182607 | Christopher Gibney | Acupuncturist | 723 Western Drive, Richmond, CA 94801 | 2008-07-23 |
| 1134320732 | Beverly Jo Skipper | Technician/Technologist | 322 Harbour Way, Suite 2, Richmond, CA 94801 | 2007-05-30 |
| 1306058383 | Judy S. Chin | Acupuncturist | 139 W. Richmond Ave., Suite 7, Pt. Richmond, CA 94801 | 2007-05-04 |
| 1720154636 | Marianne Philippek | Nurse Practitioner | 901 Nevin Avenue, Richmond, CA 94801 | 2006-11-24 |
| 1578645511 | Bridget Grace Moran | Registered Nurse | 901nevin Ave, Building C, 2nd Floor, Richmond, CA 94801 | 2006-10-19 |
| 1891875654 | Phyllis W. Zisman | Pharmacist | Kaiser Foundation Hospital, 901 Nevin Ave., Richmond, CA 94801 | 2006-10-16 |
| Find all providers in zip 94801 | ||||
| Taxonomy Code | 261QC1500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Community Health |
| Definition to come... |
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| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.