Provider Demographics
NPI:1801378435
Name:SAVING LIVES CENTER LLC
Entity Type:Organization
Organization Name:SAVING LIVES CENTER LLC
Other - Org Name:SAVING LIVES CENTER FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUWAKEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OSIDELE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C
Authorized Official - Phone:240-277-3768
Mailing Address - Street 1:3 HILLCREST DR STE A101
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-6105
Mailing Address - Country:US
Mailing Address - Phone:240-575-9940
Mailing Address - Fax:240-575-9481
Practice Address - Street 1:3 HILLCREST DR STE A101
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-6105
Practice Address - Country:US
Practice Address - Phone:240-575-9940
Practice Address - Fax:240-575-9481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-30
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR191391363LF0000X
363LP0808X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC545071YZ2QMedicaid
MD1362453Medicaid