Provider Demographics
NPI:1245809649
Name:LIFELONG DIGITAL HEALTH INC
Entity type:Organization
Organization Name:LIFELONG DIGITAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DRURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-900-3142
Mailing Address - Street 1:PO BOX 591611
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77259-1611
Mailing Address - Country:US
Mailing Address - Phone:346-408-2705
Mailing Address - Fax:
Practice Address - Street 1:2401 FOUNTAIN VIEW DR STE 461
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-4833
Practice Address - Country:US
Practice Address - Phone:346-408-2705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care