Provider Demographics
NPI:1174029474
Name:IMIND INTEGRATION HEALTH LLC
Entity Type:Organization
Organization Name:IMIND INTEGRATION HEALTH LLC
Other - Org Name:LIFE SKILLZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:703-395-2199
Mailing Address - Street 1:7877 TRAMMELL CT
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1566
Mailing Address - Country:US
Mailing Address - Phone:703-395-2199
Mailing Address - Fax:240-427-9999
Practice Address - Street 1:4703 OLD SOPER RD STE R1
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-4030
Practice Address - Country:US
Practice Address - Phone:703-395-2109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDBH000548261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation