Provider Demographics
NPI:1609082700
Name:LIFE STEPS FOUNDATION
Entity Type:Organization
Organization Name:LIFE STEPS FOUNDATION
Other - Org Name:CIRCLE OF FRIENDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-673-9915
Mailing Address - Street 1:365 E BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-3101
Mailing Address - Country:US
Mailing Address - Phone:310-673-9915
Mailing Address - Fax:310-673-0131
Practice Address - Street 1:365 E BEACH AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90302-3101
Practice Address - Country:US
Practice Address - Phone:310-673-9915
Practice Address - Fax:310-673-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70099FMedicaid