Provider Demographics
NPI:1457982720
Name:LIFELINE 2 WELLNESS
Entity Type:Organization
Organization Name:LIFELINE 2 WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BREDEHOFT
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, PMHNP-BC
Authorized Official - Phone:714-497-3307
Mailing Address - Street 1:436 E RAINIER AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-1114
Mailing Address - Country:US
Mailing Address - Phone:714-319-7208
Mailing Address - Fax:
Practice Address - Street 1:901 DOVE ST STE 299
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3036
Practice Address - Country:US
Practice Address - Phone:714-497-3307
Practice Address - Fax:714-464-4478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)