Provider Demographics
NPI:1235615410
Name:LIFE GATE HOLISITC LIVING CENTER, INC.
Entity Type:Organization
Organization Name:LIFE GATE HOLISITC LIVING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELENO CARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LIC AC, FABORM
Authorized Official - Phone:978-448-0405
Mailing Address - Street 1:66 BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450-1862
Mailing Address - Country:US
Mailing Address - Phone:978-294-9291
Mailing Address - Fax:
Practice Address - Street 1:66 BOSTON RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-1862
Practice Address - Country:US
Practice Address - Phone:978-294-9291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226478171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty