Provider Demographics
NPI:1760827919
Name:L.I.F.E., INC.
Entity Type:Organization
Organization Name:L.I.F.E., INC.
Other - Org Name:L.I.F.E. ADULT MEDICAL DAY CARE - ELDERSBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:NOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-735-5433
Mailing Address - Street 1:2822 HOLLINS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-2956
Mailing Address - Country:US
Mailing Address - Phone:410-735-5433
Mailing Address - Fax:410-814-7801
Practice Address - Street 1:2028 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6677
Practice Address - Country:US
Practice Address - Phone:410-735-5433
Practice Address - Fax:410-814-7801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:L.I.F.E., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30-027-A261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD702205100Medicaid