Provider Demographics
NPI:1275233009
Name:LIFECOURSECONNECT, LLC
Entity Type:Organization
Organization Name:LIFECOURSECONNECT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:416-783-8388
Mailing Address - Street 1:2731 DUFFERIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH YORK
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:M6B 2R3
Mailing Address - Country:CM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2731 DUFFERIN ST
Practice Address - Street 2:
Practice Address - City:NORTH YORK
Practice Address - State:ONTARIO
Practice Address - Zip Code:M6B 2R3
Practice Address - Country:CA
Practice Address - Phone:416-783-8388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare