Provider Demographics
NPI:1659838415
Name:LIFELINE MARKETING GROUP, LLC KENNETH M FOLWELL SOLE MBR
Entity Type:Organization
Organization Name:LIFELINE MARKETING GROUP, LLC KENNETH M FOLWELL SOLE MBR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:657-234-5433
Mailing Address - Street 1:57675 TWENTYNINE PALMS HWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284
Mailing Address - Country:US
Mailing Address - Phone:657-234-5433
Mailing Address - Fax:
Practice Address - Street 1:57675 TWENTYNINE PALMS HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284
Practice Address - Country:US
Practice Address - Phone:657-234-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-27
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No170300000XOther Service ProvidersGenetic Counselor, MSGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ332B00000XOther332B00000X
CA1528436367Medicaid
AZ332B00000XOtherMEDICARE