Coaching 4 Life LLC

Primary specialty

Point of ServiceTaxonomy code 305S00000X

Legal business name

COACHING 4 LIFE LLC

Practice address

31241 Casera CT
Menifee, CA 92584-8291

Phone

(619) 327-9144

NPI assigned

Sep 15, 2015

Last updated

Sep 15, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shevonte Long

Title

Owner

Phone

(619) 928-4299

Specialties & licenses 4

Addresses

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

{
    "created_epoch": "1442275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442275200000",
    "number": "1245609700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31241 CASERA CT",
            "city": "MENIFEE",
            "state": "CA",
            "postal_code": "925848291",
            "telephone_number": "619-327-9144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31241 CASERA CT",
            "city": "MENIFEE",
            "state": "CA",
            "postal_code": "925848291",
            "telephone_number": "619-327-9144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COACHING 4 LIFE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-15",
        "last_updated": "2015-09-15",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "SHEVONTE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "619-928-4299"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Point of Service in Menifee, CA
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• Point of Service in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 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.