Provider Demographics
NPI:1588378830
Name:LONG TERM HEALTH CARELINE CORP
Entity type:Organization
Organization Name:LONG TERM HEALTH CARELINE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NAKIZITO
Authorized Official - Middle Name:NAMAZZI
Authorized Official - Last Name:KAZIGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-561-0579
Mailing Address - Street 1:2000 E LAMAR BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-7337
Mailing Address - Country:US
Mailing Address - Phone:830-213-2225
Mailing Address - Fax:
Practice Address - Street 1:2000 E LAMAR BLVD STE 150
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-7337
Practice Address - Country:US
Practice Address - Phone:830-213-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty