Provider Demographics
NPI:1508576703
Name:ASPIRE LIFE CENTER LLC
Entity Type:Organization
Organization Name:ASPIRE LIFE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHENELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTIFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-530-4452
Mailing Address - Street 1:11601 STILL POND RD
Mailing Address - Street 2:
Mailing Address - City:WORTON
Mailing Address - State:MD
Mailing Address - Zip Code:21678-1706
Mailing Address - Country:US
Mailing Address - Phone:302-530-4452
Mailing Address - Fax:
Practice Address - Street 1:11601 STILL POND RD
Practice Address - Street 2:
Practice Address - City:WORTON
Practice Address - State:MD
Practice Address - Zip Code:21678-1706
Practice Address - Country:US
Practice Address - Phone:302-530-4452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty