The Life Charm Inc

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

THE LIFE CHARM INC

Practice address

1419 University Ave
San Diego, CA 92103-3459

Phone

(619) 876-4015

Fax

(619) 883-9360

NPI assigned

Sep 13, 2021

Organization subpart

No

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

Authorized official

Name

Tyler Penrod

Title

Biller

Phone

(305) 900-4715

Specialties & licenses 1

Addresses

Other names 1

• SOLUNA WELLNESS Doing business as

Locations

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

{
    "created_epoch": "1631491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678665600000",
    "number": "1295405140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6231 VISTA SAN CARLOS",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921545607",
            "telephone_number": "619-876-4015",
            "fax_number": "619-883-9360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1419 UNIVERSITY AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921033459",
            "telephone_number": "619-876-4015",
            "fax_number": "619-883-9360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LIFE CHARM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-13",
        "last_updated": "2023-03-13",
        "certification_date": "2023-03-13",
        "status": "A",
        "authorized_official_last_name": "PENROD",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "BILLER",
        "authorized_official_telephone_number": "305-900-4715"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOLUNA WELLNESS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SOLUNA WELLNESS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• The Listening Place Medical Corp
• The Macdougal-Morris Group, LLC
• The Music Therapy Center Inc
• The Neighborhood House Assn

• Adult Mental Health Clinic/Center in San Diego, CA
• Providers in San Diego, CA by specialty
• Adult Mental Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2023; 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.