Lifeline Residential Treatment Center

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

040032AP Issued in CA

Legal business name

LIFELINE RESIDENTIAL TREATMENT CENTER

Practice address

5075 Lincoln Blvd
Oroville, CA 95966-6927

Phone

(530) 282-4357

Fax

(530) 282-4948

NPI assigned

Aug 27, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Braxton Jackson, CADCCAS-RAS

Title

Executive Director

Phone

(530) 282-4357

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1440633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440633600000",
    "number": "1003283854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5075 LINCOLN BLVD",
            "city": "OROVILLE",
            "state": "CA",
            "postal_code": "959666927",
            "telephone_number": "530-282-4357",
            "fax_number": "530-282-4948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5075 LINCOLN BLVD",
            "city": "OROVILLE",
            "state": "CA",
            "postal_code": "959666927",
            "telephone_number": "530-282-4357",
            "fax_number": "530-282-4948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFELINE RESIDENTIAL TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-27",
        "last_updated": "2015-08-27",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "BRAXTON",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "530-282-4357",
        "authorized_official_credential": "CADCCAS-RAS"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "040032AP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Dawn Legg, RN
• Nicholas Paul Lemos, MSW, ASW
• Paul E Lentz, MD
• Richard M Levey, M.D.
• Rhea Y Licuanan, M.D.
• Linda Pearl Ligan
• Veronica Herrera Llerenas
• Ying Lo-Vang, NP-C
• Shella Lobo
• Tasha Loftin

• Substance Abuse Rehabilitation Facility in Oroville, CA
• Providers in Oroville, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.