Provider Demographics
NPI:1275395188
Name:LIVES SAVERS BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:LIVES SAVERS BEHAVIORAL HEALTH LLC
Other - Org Name:LIVES SAVERS BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUWAKEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OSIDELE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC
Authorized Official - Phone:240-575-9940
Mailing Address - Street 1:211 S JEFFERSON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-7012
Mailing Address - Country:US
Mailing Address - Phone:240-415-0064
Mailing Address - Fax:
Practice Address - Street 1:102 N 21ST ST # 220
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-5606
Practice Address - Country:US
Practice Address - Phone:240-415-0064
Practice Address - Fax:240-415-0209
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:-
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-25
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health