Provider Demographics
NPI:1669886909
Name:LIFEBRIDGE HEALTH CARE SERVICES, L.L.C
Entity type:Organization
Organization Name:LIFEBRIDGE HEALTH CARE SERVICES, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ABREHET
Authorized Official - Middle Name:MELES
Authorized Official - Last Name:GIRMAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-650-1578
Mailing Address - Street 1:6731 NEW HAMPSHIRE AVE APT 507
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-2803
Mailing Address - Country:US
Mailing Address - Phone:301-332-1037
Mailing Address - Fax:
Practice Address - Street 1:6731 NEW HAMPSHIRE AVE APT 507
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-2803
Practice Address - Country:US
Practice Address - Phone:301-332-1037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-15
Last Update Date:2014-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC400314001477253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC400314001477OtherBASIC BUSINESS LICENSE
DC400314001477Medicaid