| Life Uncommon, LLC | |
|
8616 La Tijera Blvd Suite 404 Los Angeles CA 90045-3944 | |
| (310) 356-9951 | |
| Not Available |
| Full Name | Life Uncommon, LLC |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 8616 La Tijera Blvd, Los Angeles, California |
| Authorized Official Name and Position | Corrie L Greathouse (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 3103569951 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Uncommon, LLC 8616 La Tijera Blvd Suite 404 Los Angeles CA 90045-3944 Ph: (310) 356-9951 | Life Uncommon, LLC 8616 La Tijera Blvd Suite 404 Los Angeles CA 90045-3944 Ph: (310) 356-9951 |
| NPI Number | 1033586698 |
|---|---|
| Provider Enumeration Date | 08/29/2015 |
| Last Update Date | 10/13/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033586698 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | () | Primary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | () | Secondary |
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