Provider Demographics
NPI:1922674282
Name:LIFE LIFT LLC
Entity Type:Organization
Organization Name:LIFE LIFT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TROMBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:240-389-5719
Mailing Address - Street 1:808 OLNEY SANDY SPRING RD STE 2D
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20860-1055
Mailing Address - Country:US
Mailing Address - Phone:240-389-5719
Mailing Address - Fax:
Practice Address - Street 1:808 OLNEY SANDY SPRING RD STE 2D
Practice Address - Street 2:
Practice Address - City:SANDY SPRING
Practice Address - State:MD
Practice Address - Zip Code:20860-1055
Practice Address - Country:US
Practice Address - Phone:240-389-5719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty