Provider Demographics
NPI:1548399694
Name:EDCA LIFESKILL
Entity Type:Organization
Organization Name:EDCA LIFESKILL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DEL RIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-622-8193
Mailing Address - Street 1:893 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-4437
Mailing Address - Country:US
Mailing Address - Phone:530-622-8193
Mailing Address - Fax:530-622-4017
Practice Address - Street 1:893 SPRING ST
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-4437
Practice Address - Country:US
Practice Address - Phone:530-622-8193
Practice Address - Fax:530-622-4017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA02239202Medicare ID - Type Unspecified