Provider Demographics
NPI:1245839877
Name:ADAPTIVE LIFE AND WELLNESS LLC
Entity type:Organization
Organization Name:ADAPTIVE LIFE AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVON
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-830-9321
Mailing Address - Street 1:14204 MARLBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-2813
Mailing Address - Country:US
Mailing Address - Phone:202-618-1122
Mailing Address - Fax:
Practice Address - Street 1:14204 MARLBOROUGH DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-2813
Practice Address - Country:US
Practice Address - Phone:202-618-1122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-24
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health