NPIMap

Organization Active NPI

Lifelong Medical Care

Doing business as Brookside Community Health Center San Pablo Dispensary

  • Non-Pharmacy Dispensing Site
  • San Pablo, CA
National Provider Identifier
1760024780
Registry record updated Oct 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
LIFELONG MEDICAL CARE
Doing business as
Brookside Community Health Center San Pablo Dispensary
Practice address
2023 Vale Rd Ste 107
San Pablo, CA 94806-3891
Phone
(510) 981-4100
NPI assigned
Oct 10, 2019
Last updated
Oct 10, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
LIFELONG MEDICAL CAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 10, 2019

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

Authorized official

Name
Kanwar D Singh
Title
Cfo
Phone
(510) 981-4122

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X Primary

Addresses

Primary practice location

2023 Vale Rd Ste 107
San Pablo, CA 94806-3891

Mailing address

PO Box 11247
Berkeley, CA 94712-2247

Other names 1

  • Brookside Community Health Center San Pablo Dispensary Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Over Sixty Health Cente44 organizations share this tax ID, including this one
Part of
Over Sixty Health Cente

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 1

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": "1570665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570665600000",
    "number": "1760024780",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2023 VALE RD STE 107",
            "city": "SAN PABLO",
            "state": "CA",
            "postal_code": "948063891",
            "telephone_number": "510-981-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFELONG MEDICAL CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFELONG MEDICAL CARE",
        "enumeration_date": "2019-10-10",
        "last_updated": "2019-10-10",
        "status": "A",
        "authorized_official_last_name": "SINGH",
        "authorized_official_first_name": "KANWAR",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "510-981-4122"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookside Community Health Center San Pablo Dispensary",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Pablo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2019; 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.