1316441223 NPI number — FAMILY LIFE FOUNDATION INCORPORATION

Table of content: (NPI 1316441223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316441223 NPI number — FAMILY LIFE FOUNDATION INCORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY LIFE FOUNDATION INCORPORATION
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:
FAMILY LIFE FOUNDATION INC
Provider Other Organization Name Type Code:
5
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:
1316441223
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11721 REISTERSTOWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REISTERSTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21136-3320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-405-3744
Provider Business Mailing Address Fax Number:
443-405-3778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11721 REISTERSTOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REISTERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21136-3320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-405-3744
Provider Business Practice Location Address Fax Number:
443-405-3778
Provider Enumeration Date:
03/23/2018

Additional Information

Authorized Official

Authorized Official Last Name:
OWOLABI
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
443-570-4860

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TP2701X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5766138000 . This is a "NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 766138000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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