1760827919 NPI number — L.I.F.E., INC.

Table of content: (NPI 1760827919)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760827919 NPI number — L.I.F.E., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
L.I.F.E., INC.
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:
6
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:
1760827919
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2822 HOLLINS FERRY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21230-2956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-735-5433
Provider Business Mailing Address Fax Number:
410-814-7801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2028 LIBERTY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELDERSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21784-6677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-735-5433
Provider Business Practice Location Address Fax Number:
410-814-7801
Provider Enumeration Date:
05/01/2013

Additional Information

Authorized Official

Authorized Official Last Name:
NOTO
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
CHARLES
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
410-735-5433

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  30-027-A , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 702205100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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