Basic Information
Provider Information | |||||||||
NPI: | 1083231088 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | PLAN-IT LIFE, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6235 RIVER CREST DR STE O | ||||||||
Address2: |   | ||||||||
City: | RIVERSIDE | ||||||||
State: | CA | ||||||||
PostalCode: | 925070758 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9516537561 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 43428 BREWSTER CT | ||||||||
Address2: |   | ||||||||
City: | TEMECULA | ||||||||
State: | CA | ||||||||
PostalCode: | 925924315 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9513023868 | ||||||||
FaxNumber: | 9513023580 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/25/2020 | ||||||||
LastUpdateDate: | 06/25/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MCLEAN | ||||||||
AuthorizedOfficialFirstName: | NYRON | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
AuthorizedOfficialTelephone: | 9516537561 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/25/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X |   |   | N |   | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 322D00000X |   |   | N |   | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children |   | 251B00000X |   |   | N |   | Agencies | Case Management |   | 251S00000X |   |   | Y |   | Agencies | Community/Behavioral Health |   |
No ID Information.