Provider Demographics
NPI:1710237177
Name:HEART FOR LIFE INC HEART FOR LIFE HEALTHCARE SERVICE
Entity Type:Organization
Organization Name:HEART FOR LIFE INC HEART FOR LIFE HEALTHCARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHEAMPONG-ANING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-293-6741
Mailing Address - Street 1:14138 CASTLE BLVD
Mailing Address - Street 2:301
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4632
Mailing Address - Country:US
Mailing Address - Phone:240-293-6741
Mailing Address - Fax:240-293-6724
Practice Address - Street 1:13992 BALTIMORE AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5010
Practice Address - Country:US
Practice Address - Phone:240-293-6741
Practice Address - Fax:240-293-6724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3563251E00000X
MD110501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD8142033-00Medicaid