Provider Demographics
NPI:1285675041
Name:LIFE LINC HABACO, INC
Entity Type:Organization
Organization Name:LIFE LINC HABACO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MURRAY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-521-2106
Mailing Address - Street 1:1228 VILLAGE WAY
Mailing Address - Street 2:SUITE N
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-4747
Mailing Address - Country:US
Mailing Address - Phone:714-480-1562
Mailing Address - Fax:714-480-1566
Practice Address - Street 1:1228 VILLAGE WAY
Practice Address - Street 2:SUITE N
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4747
Practice Address - Country:US
Practice Address - Phone:714-480-1562
Practice Address - Fax:714-480-1566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME01628FMedicaid
CADME01628FMedicaid