NPIMap

Organization Active NPI

Lifelong Jenkins Pediatric Center

  • Federally Qualified Health Center (FQHC)
  • Richmond, CA
National Provider Identifier
1407109622
Registry record updated Oct 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LIFELONG JENKINS PEDIATRIC CENTER
Practice address
120 Broadway
Suite 4
Richmond, CA 94804-1938
Phone
(510) 237-9537
Fax
(510) 237-3957
NPI assigned
Oct 25, 2012
Last updated
Oct 25, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2012

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

Authorized official

Name
Mr. Rick Clark
Title
Chief Financial Officer
Phone
(510) 981-4122

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

120 Broadway
Suite 4
Richmond, CA 94804-1938

Mailing address

PO Box 11247
Berkeley, CA 94712-2247
Phone (510) 981-4122

National Provider Directory

National Provider Directory
Tax ID family
Lifelong Medical44 organizations share this tax ID, including this one

Other organizations with this tax ID 43

Organizations that report the same tax identification number in the National Provider Directory.

View all 43

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1351123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351123200000",
    "number": "1407109622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11247",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947122247",
            "telephone_number": "510-981-4122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 BROADWAY",
            "address_2": "SUITE 4",
            "city": "RICHMOND",
            "state": "CA",
            "postal_code": "948041938",
            "telephone_number": "510-237-9537",
            "fax_number": "510-237-3957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFELONG JENKINS PEDIATRIC CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-25",
        "last_updated": "2012-10-25",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "RICK",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "510-981-4122",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2012; 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.