Provider Demographics
NPI:1205683851
Name:LIFELINE CLINICAL LABORATORY INC
Entity type:Organization
Organization Name:LIFELINE CLINICAL LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARARAT
Authorized Official - Middle Name:
Authorized Official - Last Name:BARSEGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-273-4020
Mailing Address - Street 1:7445 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-2721
Mailing Address - Country:US
Mailing Address - Phone:818-273-4020
Mailing Address - Fax:818-273-4954
Practice Address - Street 1:7445 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-2721
Practice Address - Country:US
Practice Address - Phone:818-273-4020
Practice Address - Fax:818-273-4954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D2303208OtherCLIA