Provider Demographics
NPI:1801198643
Name:LIFE LINE WOUND CARE INC.
Entity Type:Organization
Organization Name:LIFE LINE WOUND CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KAYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-992-1801
Mailing Address - Street 1:20301 VENTURA BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-0929
Mailing Address - Country:US
Mailing Address - Phone:818-992-1801
Mailing Address - Fax:818-992-1592
Practice Address - Street 1:22631 PACIFIC COAST HWY # 441
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-5036
Practice Address - Country:US
Practice Address - Phone:310-459-9889
Practice Address - Fax:206-202-4724
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFE LINE WOUND CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty