Provider Demographics
NPI:1245610807
Name:EPIC LIFE INC.
Entity Type:Organization
Organization Name:EPIC LIFE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-641-2674
Mailing Address - Street 1:1523 WHITE PL SE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-5343
Mailing Address - Country:US
Mailing Address - Phone:240-641-2674
Mailing Address - Fax:240-280-8460
Practice Address - Street 1:2305 MINNESOTA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5325
Practice Address - Country:US
Practice Address - Phone:240-641-2674
Practice Address - Fax:240-280-8460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities