1720692767 NPI number — LIFE FORCE FOR OLDER AMERICANS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720692767 NPI number — LIFE FORCE FOR OLDER AMERICANS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFE FORCE FOR OLDER AMERICANS
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:
1720692767
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3544 W CHESTER PIKE STE 216
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTOWN SQUARE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19073-4107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-356-1943
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1869 HAWK CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEVERN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21144-3114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-240-4517
Provider Business Practice Location Address Fax Number:
610-359-1117
Provider Enumeration Date:
09/08/2020

Additional Information

Authorized Official

Authorized Official Last Name:
EVEREKLIAN
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
610-356-1943

Provider Taxonomy Codes

  • Taxonomy code: 311Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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