Provider Demographics
NPI:1184858284
Name:A HOME FOR LIFE, INC.
Entity Type:Organization
Organization Name:A HOME FOR LIFE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-213-9590
Mailing Address - Street 1:12507 SUNSET AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:OCEAN CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21842-9294
Mailing Address - Country:US
Mailing Address - Phone:410-213-9590
Mailing Address - Fax:410-213-7820
Practice Address - Street 1:12507 SUNSET AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842-9294
Practice Address - Country:US
Practice Address - Phone:410-213-9590
Practice Address - Fax:410-213-7820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies