Provider Demographics
NPI:1851922066
Name:LIFEGATE, INC
Entity Type:Organization
Organization Name:LIFEGATE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:EMADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-432-7204
Mailing Address - Street 1:5010 SUNNYSIDE AVE STE 309
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-2320
Mailing Address - Country:US
Mailing Address - Phone:301-744-7412
Mailing Address - Fax:301-560-6648
Practice Address - Street 1:5010 SUNNYSIDE AVE STE 309
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2320
Practice Address - Country:US
Practice Address - Phone:301-744-7412
Practice Address - Fax:301-560-6648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities