Provider Demographics
NPI:1699127738
Name:LIFE SAVER IN-HOME SUPPORT SERVICES
Entity type:Organization
Organization Name:LIFE SAVER IN-HOME SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUFINO
Authorized Official - Middle Name:CUPIDO
Authorized Official - Last Name:BALANQUIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-214-8124
Mailing Address - Street 1:1604 RUSH AVE
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-3050
Mailing Address - Country:US
Mailing Address - Phone:760-536-6379
Mailing Address - Fax:760-215-7711
Practice Address - Street 1:1604 RUSH AVE
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-3050
Practice Address - Country:US
Practice Address - Phone:760-536-6379
Practice Address - Fax:760-215-7711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374700146253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care