NPIMap

Organization Active NPI

Lifeline Connections

  • Substance Abuse Rehabilitation Facility
  • Vancouver, WA
National Provider Identifier
1689892473
Registry record updated Mar 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
RTF - 1075 Issued in WA
Legal business name
LIFELINE CONNECTIONS
Practice address
1601 E Fourth Plain Blvd
Building 17
Vancouver, WA 98661-3753
Phone
(360) 397-8246
NPI assigned
Apr 24, 2007
Last updated
Mar 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2023

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

Authorized official

Name
Kinh Reynolds
Title
Cfo
Phone
(360) 397-8246

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X NU
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU
Substance Abuse Rehabilitation Facility 324500000X RTF - 1075 WA Primary
Family Medicine Physician 207Q00000X NU
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

1601 E Fourth Plain Blvd
Building 17
Vancouver, WA 98661-3753

Mailing address

PO Box 1678
Vancouver, WA 98668-1678
Phone (360) 397-8246

Other practice location 1

11719 NE 95th St Ste A
Vancouver, WA 98682-2444
Phone (360) 984-5511

Other practice location 2

2924 Falk Rd
Vancouver, WA 98661-5604
Phone (360) 949-3976

Other practice location 3

5197 NW Lower River Rd
Vancouver, WA 98660
Phone (360) 205-1222

Other practice location 4

6221 NE Fourth Plain Blvd Ste A
Vancouver, WA 98661-7206
Phone (360) 609-8031

Other practice location 5

11719 NE 95th St Ste D
Vancouver, WA 98682-2444
Phone (360) 397-8246

Other identifiers 1

IdentifierTypeStateIssuer
1990126MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171115003724 WA Part B Supplier - Clinic/Group Practice 2860758307 Receives reassigned benefits from 10 practitioners
3 other NPIs on this enrollment
Practice locations: Vancouver, WA; Bellingham, WA

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

11719 NE 95th St
Vancouver, WA 98682

11719 NE 95th St
Ste A
Vancouver, WA 98682
Phone (360) 954-8482

11719 NE 95th St
Ste Ad
Vancouver, WA 98682
Phone (360) 984-5511

2924 Falk Rd
Vancouver, WA 98661
Phone (360) 690-3069

Practitioners & affiliated clinicians

Practitioners 72

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.

View all 72

NPI Registry JSON

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677628800000",
    "number": "1689892473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1678",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986681678",
            "telephone_number": "360-397-8246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 E FOURTH PLAIN BLVD",
            "address_2": "BUILDING 17",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986613753",
            "telephone_number": "360-397-8246"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11719 NE 95th St Ste A",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986822444",
            "country_code": "US",
            "telephone_number": "360-984-5511",
            "fax_number": "360-984-5577",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2924 Falk Rd",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986615604",
            "country_code": "US",
            "telephone_number": "360-949-3976",
            "fax_number": "360-726-5961",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5197 NW Lower River Rd",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "98660",
            "country_code": "US",
            "telephone_number": "360-205-1222",
            "fax_number": "360-469-1720",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6221 NE Fourth Plain Blvd Ste A",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986617206",
            "country_code": "US",
            "telephone_number": "360-609-8031",
            "fax_number": "360-726-5072",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11719 NE 95th St Ste D",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986822444",
            "country_code": "US",
            "telephone_number": "360-397-8246",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIFELINE CONNECTIONS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-24",
        "last_updated": "2023-03-01",
        "certification_date": "2023-03-01",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "KINH",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "360-397-8246"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "WA",
            "license": "RTF - 1075",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1990126",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.