1710237177 NPI number — HEART FOR LIFE INC HEART FOR LIFE HEALTHCARE SERVICE

Table of content: (NPI 1710237177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710237177 NPI number — HEART FOR LIFE INC HEART FOR LIFE HEALTHCARE SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEART FOR LIFE INC HEART FOR LIFE HEALTHCARE SERVICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710237177
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14138 CASTLE BLVD
Provider Second Line Business Mailing Address:
301
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20904-4632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-293-6741
Provider Business Mailing Address Fax Number:
240-293-6724

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13992 BALTIMORE AVE
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20707-5010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-293-6741
Provider Business Practice Location Address Fax Number:
240-293-6724
Provider Enumeration Date:
09/13/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ACHEAMPONG-ANING
Authorized Official First Name:
GLADYS
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
240-293-6741

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  R3563 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251E00000X , with the licence number: 110501 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8142033-00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".