Provider Demographics
NPI:1669730156
Name:LIFELINK INC
Entity type:Organization
Organization Name:LIFELINK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER / PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DEODATO
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-643-1254
Mailing Address - Street 1:3039 W PEORIA AVE STE 102-125
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-5212
Mailing Address - Country:US
Mailing Address - Phone:888-643-1253
Mailing Address - Fax:
Practice Address - Street 1:3039 W PEORIA AVE STE 102-125
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-5212
Practice Address - Country:US
Practice Address - Phone:888-643-1253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty