Provider Demographics
NPI:1275810137
Name:LIFEBRIDGE INVESTMENTS, INC. AND SUBSIDIARIES
Entity Type:Organization
Organization Name:LIFEBRIDGE INVESTMENTS, INC. AND SUBSIDIARIES
Other - Org Name:LIFEBRIDGE COMMUNITY PRACTICES, LLC CLINICAL ASSOCIATES SLEEP CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:G
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-494-7740
Mailing Address - Street 1:515 FAIRMOUNT AVE
Mailing Address - Street 2:400
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5466
Mailing Address - Country:US
Mailing Address - Phone:410-494-1324
Mailing Address - Fax:410-494-1361
Practice Address - Street 1:515 FAIRMOUNT AVE
Practice Address - Street 2:404
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5466
Practice Address - Country:US
Practice Address - Phone:410-484-5686
Practice Address - Fax:410-484-6472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-07
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty