Provider Demographics
NPI:1477334738
Name:TOTAL LIFE CARE CENTER
Entity Type:Organization
Organization Name:TOTAL LIFE CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:QUAMINA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:510-435-7688
Mailing Address - Street 1:315 14TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-5305
Mailing Address - Country:US
Mailing Address - Phone:404-691-8880
Mailing Address - Fax:404-691-8811
Practice Address - Street 1:315 14TH ST NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-5305
Practice Address - Country:US
Practice Address - Phone:404-691-8880
Practice Address - Fax:404-691-8811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center