Provider Demographics
NPI:1508525312
Name:NORTH COUNTY LIFELINE
Entity Type:Organization
Organization Name:NORTH COUNTY LIFELINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOFFETT
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:760-842-6265
Mailing Address - Street 1:3142 VISTA WAY STE 400
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-3629
Mailing Address - Country:US
Mailing Address - Phone:760-726-4900
Mailing Address - Fax:
Practice Address - Street 1:4180 RUFFIN RD STE 295
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1834
Practice Address - Country:US
Practice Address - Phone:760-726-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH COUNTY LIFELINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health