Provider Demographics
NPI:1790181162
Name:LIFENET HEALTHCARE SERVICES, INC.
Entity Type:Organization
Organization Name:LIFENET HEALTHCARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANOKAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CM/DN
Authorized Official - Phone:301-728-4061
Mailing Address - Street 1:12812 WILLOW MARSH LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4692
Mailing Address - Country:US
Mailing Address - Phone:301-728-4061
Mailing Address - Fax:
Practice Address - Street 1:12812 WILLOW MARSH LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4692
Practice Address - Country:US
Practice Address - Phone:301-728-4061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care