Provider Demographics
NPI:1497413413
Name:LIFES ENERGY WELLNESS CENTER INC.
Entity Type:Organization
Organization Name:LIFES ENERGY WELLNESS CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:KELLEY-FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-867-2395
Mailing Address - Street 1:514 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-1834
Mailing Address - Country:US
Mailing Address - Phone:800-867-2395
Mailing Address - Fax:410-443-0842
Practice Address - Street 1:514 POPLAR ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1834
Practice Address - Country:US
Practice Address - Phone:800-867-2395
Practice Address - Fax:410-443-0842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD514Medicaid