Provider Demographics
NPI:1699020024
Name:IDEAL LIFE CALIFORNIA INC.
Entity Type:Organization
Organization Name:IDEAL LIFE CALIFORNIA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-433-2541
Mailing Address - Street 1:10736 JEFFERSON BLVD STE 640
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4933
Mailing Address - Country:US
Mailing Address - Phone:888-433-2541
Mailing Address - Fax:416-489-3009
Practice Address - Street 1:10736 JEFFERSON BLVD STE 640
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4933
Practice Address - Country:US
Practice Address - Phone:888-433-2541
Practice Address - Fax:416-489-3009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies